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

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Abstract

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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Most cited references 22

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Doing qualitative research

Author and article information

Affiliations
1Department of Family Medicine and Community Health, Mandel School of Applied Social Sciences, Case Western Reserve University, 11000 Cedar Avenue, Suite 402, Cleveland, OH 44106, USA
2School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, N2L 3G1, Canada
Author notes
CORRESPONDING AUTHOR: James J. Werner, Department of Family Medicine and Community Health, Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, OH, USA, E-mail: james.werner@123456case.edu
Journal
FMCH
Family Medicine and Community Health
FMCH
Family Medicine and Community Health & American Chinese Medical Education Association (USA)
xxx-xxx
2305-6983
September 2015
October 2015
: 3
: 3
: 18-24
Copyright © 2015 Family Medicine and Community Health

This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 Unported License (CC BY-NC 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See https://creativecommons.org/licenses/by-nc/4.0/.

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Self URI (journal page): http://fmch-journal.org/
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