Doctoral Dissertation Research: Low-income Adults and the Federal and Faith-Based Healthcare Safety Net

该项目将探讨低收入和无保险成年人的日常经历如何影响他们获得的医疗保健服务，以及他们在《平价医疗法案》（ACA）通过后的几年里，如何在安全网医疗机构中导航。在美国，低收入和没有保险的成年人是可预防慢性疾病发病率上升的主要人群，他们需要高质量的预防性医疗保健。然而，在以重大健康和福利政策变化、新自由主义私有化和安全网资源碎片化为特征的时代，在理解医疗安全网组织在低收入和无保险成年人生活中的作用方面进展甚微。本研究将分析多个数据来源，以安全网医护人员和低收入和无保险患者的看法和经验为中心，这些患者在美国东南部地区的一个中等城市使用初级保健诊所，该地区已成为新移民目的地。调查结果将直接与公共和私人安全网医疗保健组织分享，以促进这些环境中当前最佳做法的状况，其目标是改善患者医疗保健治疗结果的平等，并加强安全网组织向低收入家庭提供的资源的协调。研究问题将涉及三个具体目标。第一项研究系统地调查了生活过程中围绕健康、家庭、居住和就业的转变如何影响低收入和无保险的成年人何时以及如何进入医疗安全网组织。第二部分将评估医疗保健系统、福利系统和官僚机构的性别和种族化特征如何塑造公共和私人初级保健安全网设置的组织逻辑，并在个体工作者寻求改善患者日常生活时对他们的努力进行制裁。第三篇试图澄清医疗安全网组织在塑造低收入成年人的态度、感受和健康期望以及他们可获得的各种资源方面的作用。这些目标将通过对一个私人初级保健机构和一个联邦合格保健中心的比较人种学案例研究来实现。该方法结合了基于团队的纵向人种学方法、定性访谈和患者电子医疗记录。分析将检查组织的政策，工人的态度和经验，以及病人的态度和经验。

Title: Unpacking Inequality in the Faith-Based and Federal Healthcare Safety NetThe project will explore how the everyday experiences of low-income and uninsured adults shape both the healthcare they have access to and the ways in which they navigate safety-net healthcare organizations in the years following the passage of the Affordable Care Act (ACA). Low-income and uninsured adults in the U.S. are the leading edge in the rising incidence of preventable chronic illness and need high-quality preventive healthcare. However, little progress has been made in understanding the role of healthcare safety-net organizations in the lives of low-income and uninsured adults in an era characterized by significant health and welfare policy changes, neoliberal privatization, and safety net resource fragmentation. This study will analyze multiple data sources centered on the perceptions and experiences of safety net healthcare workers and low-income and uninsured patients who use primary care clinics in a mid-sized city in the southeast region of the U.S. which has become a New Immigrant Destination. Findings will be shared directly with public and private safety-net healthcare organizations to advance the state of current best practices in these settings, with the goals of improving equality in healthcare treatment outcomes among patients and enhancing the coordination of resources provided across safety-net organizations to low-income families. Research questions will address three specific aims. The first involves a systematic investigation of how life course transitions around health, family, residence, and employment shape when and how low-income and uninsured adults enter healthcare safety net organizations. The second will assess how gendered and racialized features of healthcare systems, welfare systems, and bureaucratic institutions shape the organizational logics of public and private primary care safety-net settings and sanction the efforts of individual workers as they seek to improve their patients' everyday lives. The third seeks to clarify the role of healthcare safety-net organizations in shaping the attitudes, feelings, and health expectations of low-income adults and the kinds of resources available to them. These aims will be addressed through a comparative ethnographic case study of one private primary care setting and one federally qualified health center. The methodology incorporates team-based longitudinal ethnographic methods, qualitative interviews, and patient electronic medical records. The analysis will examine organizational policies, worker attitudes and experiences, and patient attitudes and experiences.