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Open Access Primary care clinicians’ strategies to overcome financial barriers to specialty health care for uninsured patients

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Objective: This study describes strategies used by federally qualified health centers (FQHCs) to assist medically uninsured patients in obtaining specialty health care services.

Methods: Qualitative methods were used to study strategies for obtaining specialty health care for uninsured patients. Data were gathered from 10 primary care clinicians at three FQHC clinics by means of 10 semistructured interviews, 23 brief interviews, and 45 h of direct observations. We captured additional data by studying cases of referred uninsured patients.

Results: The following six strategies were identified: (1) quid pro quo ‐ a specialist accepting the clinic’s medically uninsured patients was rewarded with referrals of the clinic’s insured patients; (2) over referral ‐ clinicians referred insured patients whose needs could have been met at the FQHC; (3) brief hospitalization ‐ when a specialist could not be obtained, high-risk patients were briefly hospitalized; (4) case building ‐ diagnostic tests were conducted at the FQHC to justify a referral; (5) direct communication ‐ communication between clinicians and specialists was necessary when requesting a referral; (6) specialty clinics ‐ in return for conducting a specialty clinic at the FQHC, the specialist received all referrals of insured patients.

Conclusion: Uninsured FQHC patients encountered difficulties accessing specialty health care, and in response, clinicians developed a range of innovative strategies.

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Keywords: Health services accessibility; access to specialty care, qualitative methods; barriers to health care; health care inequities; medically uninsured

Document Type: Research Article

Publication date: September 1, 2015

This article was made available online on September 4, 2015 as a Fast Track article with title: "Primary care clinicians’ strategies to overcome financial barriers to specialty health care for uninsured patients".

More about this publication?
  • Family Medicine and Community Health (FMCH) is an open-access journal focusing on subjects that are common and relevant to family medicine/general practice and community health. The journal publishes relevant content across disciplines such as epidemiology, public health, social and preventive medicine, research and evidence based medicine, community health service, patient education and health promotion and health ethics. The journal has a specific focus on the management of chronic illness particularly diabetes, ischaemic heart disease, chronic heart failure, hypertension, bronchial asthma, chronic obstructive airways disease and common mental illness. FMCH is published by Compuscript on behalf of the Chinese General Practice Press

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