Improving Health Care for the Future Uninsured in Los Angeles County: A Community-Partnered Dialogue.


OBJECTIVE To understand the health care access issues faced by Los Angeles (LA) County's uninsured and residually uninsured after implementation of the Affordable Care Act (ACA) and to identify potential solutions using a community-partnered dialogue. DESIGN Qualitative study using a community-partnered participatory research framework. SETTING Community forum breakout discussion. DISCUSSANTS Representatives from LA County health care agencies, community health care provider organizations, local community advocacy and service organizations including uninsured individuals, and the county school district. MAIN OUTCOME MEASURES Key structural and overarching value themes identified through community-partnered pile sort, c-coefficients measuring overlap between themes. RESULTS Five overarching value themes were identified - knowledge, trust, quality, partnership, and solutions. Lack of knowledge and misinformation were identified as barriers to successful enrollment of the eligible uninsured and providing health care to undocumented individuals. Discussants noted dissatisfaction with the quality of traditional sources of health care and a broken cycle of trust and disengagement. They also described inherent trust by the uninsured in "outsider" community-based providers not related to quality. CONCLUSIONS Improving health care for the residually uninsured after ACA implementation will require addressing dissatisfaction in safety-net providers, disseminating knowledge and providing health care through trusted nontraditional sources, and using effective and trusted partnerships between community and health care agencies with mutual respect. Community-academic partnerships can be a trusted conduit to discuss issues related to the health care of vulnerable populations.

DOI: 10.18865/ed.25.4.487

Cite this paper

@article{Iyer2015ImprovingHC, title={Improving Health Care for the Future Uninsured in Los Angeles County: A Community-Partnered Dialogue.}, author={S. Purushothaman Iyer and Andrea D Jones and Efrain Talamantes and Elizabeth S Barnert and Hemal K. Kanzaria and Alissa A Detz and Timothy J. Daskivich and Loretta Jones and Gery Ryan and Anish P. Mahajan}, journal={Ethnicity & disease}, year={2015}, volume={25 4}, pages={487-94} }