Raising the Bar, Lowering the Barriers: A Program Refocused from Acute to Chronic Health

• In Event: 480 - Section on Medical Sociology Refereed Roundtable Session and Business Meeting
  In Refereed Roundtable 60min: Table 07. Health Policy

Abstract

Behind the partisan rhetoric over funding of the Affordable Care Act is a marked shift in the proportion of health care services delivered in response to preventable chronic disease rather than acute illness. Massachusetts led the nation in adopting a universal health care policy and as a result, before the ACA, changed the focus of a public health program from increasing access to cancer screening and testing to assisting low-income patients with chronic disease. This paper uses surveys of program patients before and after this change, as well as qualitative interviews with a subsample, to analyze the consequences of this natural experiment for patient characteristics and patient satisfaction with their health care. The analysis identifies a dramatic reduction in financial barriers to health care and greater diversity in the population served, but reduced satisfaction with the program and continuing impact on satisfaction of practical barriers encountered in health care delivery. Conclusions highlight the importance of personal staff-patient relations and the difficulties of delivering effective care for chronic disease. Implications are drawn for challenges faced in implementation of the ACA.

Author

• Russell K. Schutt, University of Massachusetts-Boston