Abstract：
BACKGROUND AND OBJECTIVES:Central to health insurance reform discussions was the recurring question: why are eligible children not enrolled in public insurance programs? We interviewed families with children eligible for public insurance to (1) learn how they view available services and (2) understand their experiences accessing care. METHODS:Semi-structured, in-depth interviews with 24 parents of children eligible for public coverage but not continuously enrolled were conducted. We used a standard iterative process to identify themes, followed by immersion/crystallization techniques to reflect on the findings. RESULTS:Respondents identified four barriers: (1) confusion about insurance eligibility and enrollment, (2) difficulties obtaining public coverage and/or services, (3) limited provider availability, and (4) non-covered services and/or coverage gaps. Regardless of whether families had overcome these barriers, all had experienced stigma associated with needing and using public assistance. There was not just one point in the process where families felt stigmatized. It was, rather, a continual process of stigmatization. We present a theoretical framework that outlines how families continually experience stigma when navigating complex systems to obtain care: when they qualify for public assistance, apply for assistance, accept the assistance, and use the public benefit. This framework is accompanied by four illustrative archetypes. CONCLUSIONS:This study provides further insight into why some families forego available public services. It suggests the need for a multi-pronged approach to improving access to health care for vulnerable children, which may require going beyond incremental changes within the current system.
journal_name
Fam Medjournal_title
Family medicineauthors
DeVoe JE,Westfall N,Crocker S,Eigner D,Selph S,Bunce A,Wallace Lsubject
Has Abstractpub_date
2012-01-01 00:00:00pages
39-46issue
1eissn
0742-3225issn
1938-3800journal_volume
44pub_type
杂志文章相关文献
FAMILY MEDICINE文献大全abstract：BACKGROUND AND OBJECTIVES:More effective diabetes care is desperately needed, especially for ethnic minority populations. Provider cultural competence promises to be an important means for reducing disparities in outcomes for patients with diabetes. The objectives of this study were to understand the role of cultural c...
journal_title：Family medicine
pub_type： 杂志文章
doi：
更新日期：2013-06-01 00:00:00
abstract：BACKGROUND AND OBJECTIVES:This is the 33rd annual report prepared by the American Academy of Family Physicians (AAFP) that reports retrospectively the percentage of graduates from US MD and DO-granting medical schools who entered an Accreditation Council for Graduate Medical Education (ACGME)-accredited family medicine...
journal_title：Family medicine
pub_type： 杂志文章
doi：
更新日期：2014-10-01 00:00:00
abstract：BACKGROUND:This study was conducted to validate a shortened version of the Rapid Estimate of Adult Literacy in Medicine (REALM). This screening instrument is designed to be used in public health and primary care settings to identify patients with low reading levels. It provides reading grade estimates for patients who ...
journal_title：Family medicine
pub_type： 杂志文章
doi：
更新日期：1993-06-01 00:00:00
abstract：:The results of the 1996 National Resident Matching Program (NRMP) set records in the number of positions filled in family practice residencies, with a 10.8% increase over 1995 (2,840 vs 2,563) and a 9.4% increase in positions filled with US seniors (2,276 vs 2,081). This is the largest number of US seniors choosing fa...
journal_title：Family medicine
pub_type： 杂志文章
doi：
更新日期：1996-09-01 00:00:00
abstract：BACKGROUND AND OBJECTIVES:Physician workforce projections fuel interest in addressing the shortage of family physicians. Copious research has investigated personality as a variable influencing specialty intention. Medical school rural longitudinal integrated clerkships (LICs) nurture interest in family medicine. This s...
journal_title：Family medicine
pub_type： 杂志文章
doi：
更新日期：2015-03-01 00:00:00
abstract：:Routine neonatal circumcision has long been controversial. Presented here is a cost-effectiveness analysis of the consequences of the treatment choices (circumcision versus no circumcision) using a decision tree model. For a simulated 85-year life expectancy, routine neonatal circumcision had an expected lifetime cost...
journal_title：Family medicine
pub_type： 杂志文章,评审
doi：
更新日期：1991-11-01 00:00:00
abstract：BACKGROUND:Rotations by American medical students in foreign countries have been common in US medical schools for nearly half a century. Although anecdotal literature makes claims for the significant educational value of these foreign rotations, neither the nature and educational consequences of these experiences, nor ...
journal_title：Family medicine
pub_type： 杂志文章
doi：
更新日期：1994-04-01 00:00:00
abstract：:After 3 decades in private practice, I joined the faculty of a nearby residency program. Like most family medicine residencies, it follows a curriculum that my physician father would have recognized: heavy emphasis on inpatient medicine; short shrift to continuity care. Despite a changing marketplace, there is still a...
journal_title：Family medicine
pub_type： 杂志文章
doi：10.22454/FamMed.2019.633317
更新日期：2019-07-01 00:00:00
abstract：:To encourage pursuit of focused academic and clinical interest by family practice residents, we developed an Area of Concentration (AOC) program at a university-based residency program. The program uses resources available throughout the university and permits residents to focus on a variety of interest areas, includi...
journal_title：Family medicine
pub_type： 杂志文章
doi：
更新日期：1993-04-01 00:00:00
abstract：BACKGROUND AND OBJECTIVES:The number of family physicians providing obstetric deliveries is decreasing, but high numbers of new graduates report they intend to include obstetric deliveries in their practices. The objective of this study was to understand barriers to providing obstetrical care faced by recent family med...
journal_title：Family medicine
pub_type： 杂志文章
doi：10.22454/FamMed.2019.845581
更新日期：2019-05-01 00:00:00
abstract：:Physicians have tended to label the patient who doesn't follow their advice as resistant and noncompliant. However, compliance studies have not identified the physician's sometimes unwitting complicity in the noncompliance. Some physician-patient partnerships are marked by an intensifying power struggle which may have...
journal_title：Family medicine
pub_type： 杂志文章
doi：
更新日期：1986-03-01 00:00:00
abstract：:The clinical relationship of academic family practice units to their parent tertiary care medical centers was studied. We surveyed the designated family practice contacts in all U.S. medical schools and achieved a response rate of 84%. We found wide variations in the degree to which academic family practice units prov...
journal_title：Family medicine
pub_type： 杂志文章
doi：
更新日期：1987-03-01 00:00:00
abstract：BACKGROUND AND OBJECTIVES:Electronic prescribing is one of the components of the Patient-centered Medical Home and is one of the "meaningful use" criteria to qualify electronic medical records for financial incentives. While there are many potential benefits of electronic prescribing, documentation of these is currentl...
journal_title：Family medicine
pub_type： 杂志文章
doi：
更新日期：2010-05-01 00:00:00
abstract：BACKGROUND AND OBJECTIVES:Family medicine residents are required to maintain a continuity practice in an approved family medicine center (FMC) and achieve minimum targets for patient encounters. In the past, minimum periods of time in the FMC were defined in the program requirements, but these have now been replaced wi...
journal_title：Family medicine
pub_type： 杂志文章
doi：
更新日期：2013-11-01 00:00:00
abstract：BACKGROUND AND OBJECTIVES:As the use of esophagogastroduodenoscopy (EGD) by family physicians increases, a need exists to further demonstrate the procedure's clinical effectiveness and safety and the general experience of family physicians performing the procedure. This study examines the general experience of a group ...
journal_title：Family medicine
pub_type： 杂志文章
doi：
更新日期：1995-09-01 00:00:00
abstract：BACKGROUND AND OBJECTIVES:Terrorism may have a severe impact on physicians' practices. We examined terrorism preparedness training of office-based physicians. METHODS:The National Ambulatory Medical Care Survey uses a nationally representative multi-stage sampling design. In 2003 and 2004, physicians were asked if the...
journal_title：Family medicine
pub_type： 杂志文章
doi：
更新日期：2007-05-01 00:00:00
abstract：BACKGROUND AND OBJECTIVES:A personal physician and enhanced access to care are principles of the patient-centered medical home. Despite the importance of these concepts, measuring and improving interpersonal continuity of care and access to care in academic family medicine centers has received little attention. The aut...
journal_title：Family medicine
pub_type： 杂志文章
doi：
更新日期：2016-02-01 00:00:00
abstract：BACKGROUND AND OBJECTIVES:Intimate partner violence (IPV) is a silent epidemic affecting one in three women. The US Preventive Services Task Force recommends routine IPV screening for women of childbearing age, but actual rates of screening in primary care settings are low. Our objectives were to determine how often IP...
journal_title：Family medicine
pub_type： 杂志文章
doi：10.22454/FamMed.2018.311843
更新日期：2018-10-01 00:00:00
abstract：:The maturation process of family practice intensifies the need for our educators to unify their material into concepts specific to our specialty. A method of teaching clinical topics is described in which integrative goals are combined with knowledge, skill, and attitudinal goals. The attitudinal goals are designed to...
journal_title：Family medicine
pub_type： 杂志文章
doi：
更新日期：1985-05-01 00:00:00
abstract：:This pilot study was undertaken to better understand the families of patients with somatization disorder. Two complementary methods were used to study six patients with somatization disorder and six control patients. The first method was a semistructured clinical family interview which was videotaped and independently...
journal_title：Family medicine
pub_type： 杂志文章
doi：
更新日期：1989-11-01 00:00:00
abstract：PURPOSE:The BELIEF Instrument is a cultural interviewing tool for preclinical medical students that does not require diagnostic or therapeutic skills. METHODS:An expert panel developed and taught the instrument to 200 first-year medical students in (1) a didactic session, (2) standardized patient interviews, and (3) c...
journal_title：Family medicine
pub_type： 杂志文章
doi：
更新日期：2003-05-01 00:00:00
abstract：OBJECTIVE:This study describes an international acupuncture elective and its impact on medical students' development of cultural competence. METHODS:Collaborating with Chinese colleagues, we created a 4-week elective that teaches medical students about acupuncture in its native cultural environment. Three focus groups...
journal_title：Family medicine
pub_type： 杂志文章
doi：
更新日期：2007-01-01 00:00:00
abstract：:Practice management curriculum must evolve to more thoroughly address the areas of personnel recruitment. A recent report by the Medical Group Management Association indicated that nearly half of a family practitioner's practice overhead goes for personnel. This paper presents a recruitment curriculum designed as a jo...
journal_title：Family medicine
pub_type： 杂志文章
doi：
更新日期：1988-09-01 00:00:00
abstract：BACKGROUND AND OBJECTIVES:This study determined the perceived characteristics of family practice residency training programs that produce a high percentage of graduates who provide maternity care. METHODS:We surveyed a Delphi panel of 28 family practice maternity care experts. RESULTS:Consensus was reached after the ...
journal_title：Family medicine
pub_type： 杂志文章
doi：
更新日期：1997-11-01 00:00:00
abstract：BACKGROUND AND OBJECTIVES:Much attention is devoted nationally to preventing hospital readmissions and emergency department (ED) use, given the high cost of this care. There is a growing body of evidence from the Patient Centered Primary Care Collaborative that a patient-centered medical home (PCMH) model successfully ...
journal_title：Family medicine
pub_type： 杂志文章
doi：
更新日期：2017-01-01 00:00:00
abstract：BACKGROUND:Family-oriented medical care is one of the basic tenets of family practice. However, little is known about the extent to which: 1) resident physicians discuss family issues during outpatient office visits and 2) attending physicians address family issues during teaching consultations. METHODS:Two hundred an...
journal_title：Family medicine
pub_type： 杂志文章
doi：
更新日期：1993-01-01 00:00:00
abstract：BACKGROUND:This pilot study describes an Objective Structured Clinical Examination (OSCE) developed using Human Patient Simulation (HPS). METHODS:Eight residents completed two iterations of this HPS OSCE containing seven stations and utilizing checklists, global ratings, and scoring sheets. RESULTS:The first- and sec...
journal_title：Family medicine
pub_type： 杂志文章
doi：
更新日期：2010-10-01 00:00:00
abstract：BACKGROUND:We conducted a pilot test of accreditation guidelines for family medicine faculty development fellowship programs from September 1997 to March 1999. The accreditation guidelines included 8 application categories with 27 requirements and 5 self-study criteria. The process included completion of the accreditat...
journal_title：Family medicine
pub_type： 杂志文章
doi：
更新日期：2000-11-01 00:00:00
abstract：BACKGROUND:Family physicians have been involved in the care of rural and urban underserved populations since the founding of the specialty. In the early 1970s family medicine training programs specifically focused on training residents to work with the underserved were established in both urban and rural settings. Key ...
journal_title：Family medicine
pub_type： 历史文章,杂志文章
doi：
更新日期：2017-04-01 00:00:00
abstract：BACKGROUND AND OBJECTIVES:Patients' health literacy is a growing concern as patients are expected to perform more self-care. While many US schools implement health literacy in their curricula, time spent on the topic ranges from 0 to 8 hours and is largely didactic. Evaluation of health literacy skills is not well defi...
journal_title：Family medicine
pub_type： 杂志文章
doi：10.22454/FamMed.2018.539107
更新日期：2018-01-01 00:00:00
