EN ES
Vol. 23. Num. 2. 2014. Pages 115-123

Empowered and disempowered voices of low-income people with disabilities onthe initiation of government-funded, managed health care

[La opinión autorizada y desautorizada de personas de bajos ingresos al iniciar la asistencia sanitaria gestionada financiada públicamente]

Kathleen McAuliff1 , Judah J. Viola1 , Christopher B. Keys1 , Lindsey T. Back1 , Amber E. Williams1 , Crystal N. Steltenpohl1

1Univ. Illinois at Chicago, Dep. Disability and Human Development, Estados Unidos

Abstract

The health and healthcare of vulnerable populations is an international concern. In 2011, a Midwesternstate within the U.S. mandatorily transitioned 38,000 Medicaid recipients from a fee-for-service systeminto a managed care program in which managed care companies were contracted to provide recipients'healthcare for a capitated rate. In addition to cost savings through reductions in preventable andunnecessary hospital admissions, the goals of the managed care program (MCP) included: (1) access to amore functional support system, which can support high and medium risk users in the development ofcare plans and coordination of care, and (2) choice among competent providers. The population transitionedwas a high-need, high-cost, low-income, and low-power group of individuals. The evaluation researchteam used focus groups as one of many strategies to understand the experience of users during the firsttwo years of this complex change effort. The article explores empowerment in terms of users and theirfamily caregivers' ability to make meaningful choices and access resources with regard to their healthcare.Specifically, factors empowering and disempowering users were identified within three thematic areas: (1)enrollment experiences, (2) access to care and (3) communication with managed care organizations andproviders. While the change was not optional for users, a disempowering feature, there remainedopportunities for other empowering and disempowering processes and outcomes through the transitionand new managed care program. The results are from 74 participants: 65 users and 9 family caregivers in11 focus groups and six interviews across two waves of data collection. MCP users felt disempowered by aninitial lack of providers, difficulty with transportation to appointments, and challenges obtaining adequatemedication. They felt empowered by having a choice of providers, good quality of transportation servicesand clear communication from providers and managed care organizations. Recommendations forincreasing prospects for the empowerment of healthcare users with disabilities within a managed careenvironment are presented. 

Resumen

La salud y su atención en poblaciones vulnerables preocupa internacionalmente. Un Estado del medio-oesteestadounidense en 2011 traspasó obligatoriamente a 38.000 receptores de Medicaid de un sistema depago por servicio a un programa de asistencia gestionada en el que se contrataba a empresas de asistenciagestionada para la prestación de asistencia sanitaria a los usuarios por una cuota por persona. Además delos ahorros por la disminución de admisiones hospitalarias evitables e innecesarias, los objetivos del programagestionado de asistencia incluían: (1) el acceso a un sistema de apoyo más funcional para usuariosde un riesgo elevado y medio en el desarrollo de planes de asistencia y coordinación de la misma y (2) laelección entre proveedores competentes. La población a la que afecta este traspaso era un grupo de personasmuy necesitadas, que entrañaban costes elevados, con un nivel bajo de ingresos y de poder. El equipoinvestigador de evaluación utilizó grupos de discusión como una de las muchas estrategias para entender laexperiencia de los usuarios durante los dos primeros años de este esfuerzo complejo de cambio. El artículoexplora el "empowerment" en cuanto a los usuarios y a la capacidad de quienes prestan asistencia a su familia de tomar las decisiones oportunas y acceder a los recursos relativos la prestación de asistencia sanitaria.En concreto, los factores que reforzarían o debilitarían a los usuarios pueden pertenecer a tres áreastemáticas: (1) experiencias de enrolamiento, (2) acceso a la asistencia y (3) la comunicación con las organizacionescon quienes proporcionan asistencia sanitaria gestionada. A pesar de que el cambio no era optativopara los usuarios, un aspecto negativo, aún quedaba margen para otros procesos de capacitación, incapacitacióny resultados gracias a la transición y al nuevo programa gestionado de asistencia. Se dispone de resultadosde 74 participantes, 65 usuarios y 9 personas que prestan asistencia a la familia en 11 grupos dediscusión, con 6 entrevistas en dos tandas de recogida de datos. Los usuarios del programa gestionado deasistencia sintieron desvalimiento por la falta inicial de proveedores, los problemas de transporte a las citasy para conseguir la medicación adecuada. En cambio se sintieron reforzados por el hecho de tener unagama de proveedores, una buena calidad de servicios de transporte y comunicación clara por parte de losproveedores y de las organizaciones de asistencia gestionada. Se ofrecen recomendaciones para mejorar lasperspectivas de reforzamiento (empowerment) de los usuarios de asistencia sanitaria con discapacidadesen un entorno de prestación gestionada de asistencia. 

Keywords

Managed care
Marginalized group
Disability
Healthcare policy

Palabras clave

Asistencia gestionada
Grupo marginado
Discapacidad
Políticas de asistencia sanitaria
References
Allen et al., 2012
E.P. Allen
W. Cappelletto
S. Siegel
The impact of state Medicaid reform on vulnerable populations needing long-term care services and supports: An analysis of Florida, Illinois, and New Jersey
NAELA Journal
8
2012
125-61
Auerbach and Silverstein, 2003
C.F. Auerbach
L.B. Silverstein
Qualitative data: An introduction to coding and analysis
2003
Berenson and Rich, 2010
R.A. Berenson
E.C. Rich
US Approaches to physician payment: The deconstruction of primary care
Journal of General Internal Medicine
25
2010, May
613-8
Betancourt et al., 2003
J.R. Betancourt
A.R. Green
J.E. Carrillo
O. Ananeh-Firempong 2nd
Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care
Public Health Reports
118
2003
293-302
Bielaszka-DuVernay, 2011
C. Bielaszka-DuVernay
Improving the coordination of care for Medicaid beneficiaries in Pennsylvania
Health Affairs
30
2011
426-30
Bond and Keys, 2014
Bond, M.A., & Keys, C. Empowerment, diversity, and collaboration: Promoting synergy on community boards. American Journal of Community Psychology, 21, 37-58.
Centers for Medicare and Medicaid Services, 2014
Centers for Medicare & Medicaid Services (n.d.). Key milestones in CMS programs.
Croom et al., 2011
A. Croom
D.J. Wiebe
C.A. Berg
R. Lindsay
D. Donaldson
C. Foster
M.T. Swinyard
Adolescent and parent perceptions of patient-centered communication while managing type 1 diabetes
Journal of pediatric psychology
36
2011
206-15
Dorsey, 1975
J.L. Dorsey
The Health Maintenance Organization Act of 1973 (PL 93-222) and prepaid group practice plans
Medical Care
13
1975
1-9
Drainoni et al., 2006
M.-L. Drainoni
E. Lee-Hood
C. Tobias
S.S. Bachman
J. Andrew
L. Maisels
Cross-disability experience of barriers to health-care access: Consumer perspectives
Journal of Disability Policy Studies
17
2006
101-15
Fiscella et al., 2000
K. Fiscella
P. Franks
M.R. Gold
C.M. Clancy
Inequality in quality: addressing socioeconomic, racial, and ethnic disparities in health care
JAMA
283
2000
2579-84
Foster-Fishman et al., 1998
P.G. Foster-Fishman
D.A. Salem
S. Chibnall
R. Legler
C. Yapchai
Empirical support for the critical assumptions of empowerment theory
American Journal of Community Psychology
26
1998
507-36
Hare et al., 2006
C. Hare
J. Law
C. Brennan
The vulnerable healthcare consumer: An interpretive synthesis of the patient experience literature
International Journal of Consumer Studies
37
2006
299-311
Jurkowski et al., 2002
E. Jurkowski
B. Jovanovic
L. Rowitz
Leadership/citizen participation: perceived impact of advocacy activities by people with physical disabilities on access to health care, attendant care and social services
Journal of Health & Social Policy
14
2002
49-61
Kim et al., 2008
S.C. Kim
S. Kim
D. Boren
The quality of therapeutic alliance between patient and provider predicts general satisfaction
Military Medicine
173
2008
85-90
Koh et al., 2013
H.K. Koh
C. Brach
L.M. Harris
M.L. Parchman
A proposed ‘health literate care model’ would constitute a systems approach to improving patients’ engagement in care
Health Affairs
32
2013
357-67
Marmot, 2013
Marmot, M. (2013). Health inequalities in the European Union: Final report of a consortium. Brussels: European Commission Directorate-General for Health and Consumers. ISBN 978-92-79-30898-7. doi: 10.2772/34426.
Medicaid, 2014
Medicaid (2014). HYPERLINK h t t p & # 5 8 ; & # 4 7 ; & # 4 7 ; w w w & # 4 6 ; m e d i c a i d & # 4 6 ; g o v & # 4 7 ; M e d i c a i d - C H I P - P r o g r a m - I n f o r m a t i o n & # 4 7 ; B y - T o p i c s & # 4 7 ; D e l i v e r y - S ystems/Medicaid-Managed-Long-Term-Services-and-Supports-MLTSS.html.
National Association for States, 2014
National Association for States United for Aging and Disability (2014). http://www. nasuad.org.
Rappaport, 1987
J. Rappaport
Terms of empowerment/exemplars of prevention: Toward a theory for community psychology
American Journal of Community Psychology
15
1987
121-48
Ravesloot et al., 2005
C. Ravesloot
T. Seekins
G. White
Living Well With a Disability health promotion intervention: improved health status for consumers and lower costs for health care policymakers
Rehabilitation Psychology
50
2005
239-45
Riger, 1993
S. Riger
What's wrong with empowerment
American Journal of Community Psychology
21
1993
279-91
Rohrer et al., 2008
J.E. Rohrer
L. Wilshusen
S.C. Adamson
S. Merry
Patient centeredness, self-rated health, and patien empowerment: should providers spend more time communicating with their patients?
Journal of Evaluation in Clinical Practice
14
2008
548-51
Root and Stableford, 1999
J. Root
S. Stableford
Easy-to-read consumer communications: a missing link in Medicaid managed care
Journal of Health Politics Policy and Law
24
1999
1-26
Sekhri, 2000
N.K. Sekhri
Managed Care: The US Experience
Bulletin of the World Health Organization.
78
2000
830-44
Thorpe et al., 2001
K.E. Thorpe
E.E. Seiber
C.S. Florence
The impact of HMOs on hospital-based uncompensated care
Journal of Health Politics Policy, and Law
26
2001, June
543-55
Wallerstein and Bernstein, 1994
N. Wallerstein
E. Bernstein
Introduction to community empowerment, participatory education, and health
Health Education Quarterly
21
1994
141-8
Vázquez et al., 2009
M.L. Vázquez
I. Vargas
J. Unger
A. Mogollón
M. Silva
F. Rejane
P. Paepe
Integrated health care networks in Latin America: toward a conceptual framework for analysis
Revista Panamericana de Salud Pública
26
2009
360-7
Zimmerman, 2000
M.A. Zimmerman
Empowerment theory
Handbook of community psychology
Springer
US
2000
43-63

Copyright © 2018. Colegio Oficial de Psicólogos de Madrid

© Copyright 2018. Colegio Oficial de Psicólogos de Madrid ContactPrivacy PolicyCookies Policy

We use our own and third­party cookies. The data we compile is analysed to improve the website and to offer more personalized services. By continuing to browse, you are agreeing to our use of cookies. For more information, see our cookies policy

Aceptar