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

Empowered and disempowered voices of low-income people with disabilities on the 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


https://doi.org/10.1016/j.psi.2014.07.003

Abstract

The health and healthcare of vulnerable populations is an international concern. In 2011, a Midwestern state within the U.S. mandatorily transitioned 38,000 Medicaid recipients from a fee-for-service system into 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 and unnecessary hospital admissions, the goals of the managed care program (MCP) included: (1) access to a more functional support system, which can support high and medium risk users in the development of care plans and coordination of care, and (2) choice among competent providers. The population transitioned was a high-need, high-cost, low-income, and low-power group of individuals. The evaluation research team used focus groups as one of many strategies to understand the experience of users during the first two years of this complex change effort. The article explores empowerment in terms of users and their family 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 and providers. While the change was not optional for users, a disempowering feature, there remained opportunities for other empowering and disempowering processes and outcomes through the transition and 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 an initial lack of providers, difficulty with transportation to appointments, and challenges obtaining adequate medication. They felt empowered by having a choice of providers, good quality of transportation services and clear communication from providers and managed care organizations. Recommendations for increasing prospects for the empowerment of healthcare users with disabilities within a managed care environment 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
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