Navigating the health care system: a view from the urban medically underserved

The purpose of this project was to discover areas identified by minority and underserved patients that lead to dissatisfaction with the health care system and specific areas identified as barriers to health. Six focus groups (n=25) were conducted, with participants including mostly poor African-American adults with and without a primary care home, in addition to 1 group of community dwelling mentally ill patients, and 1 group of case managers for community dwelling mentally ill patients who navigate the health care system for their clients. Qualitative analysis by 3 authors identified themes emerging from the focus groups. The following themes were identified: (1) difficulty with insurance, including coverage, accessibility, stability, and choices; (2) socioeconomic, more than racial, barriers to care; (3) a misunderstanding or lack of information about the health care system and a lack of health literacy; and (4) lack of personal accountability for health and health care. Patients with access to a primary care home seemed more satisfied with the health care system. An increase in health literacy education and simplification of insurance policies and procedures could increase satisfaction and possibly improve outcomes for underserved patients. Providing preventive care and improving patient accountability for personal health may also improve satisfaction and outcomes.