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

Duke University, Durham NC

Investigators

Abstract

Title: Unpacking Inequality in the Faith-Based and Federal Healthcare Safety Net The 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.