Human experience overcoming demand side rationing in the United States

This research tells the detailed human experience of six persons who are sick enough to need care beyond primary care and who are without the personal wealth or health insurance to access health care. Each participant is a person who overcame demand side rationing without having an ability to pay the asking price for advanced health care. The participants were recruited from three federally qualified community health centers and two free clinics in the upper Midwest, and participants were required to be aged 18-64, without health insurance, sick enough to need more than primary care, and appointed with some form of advanced health care. Participants contacted the researcher on a toll-free line and signed informed consent prior to the first interview. Inquiry was organized around questions about personal experience, educative influence, and learning. Data sources included environmental profiles, three interviews, one health care observation, and limited clinical literature. Environmental profiles focused on each person's recruitment source, home, community, and advanced health care provider. The semi-structured qualitative interviews required 4-6 weeks, the first emphasizing background, the second about health care experience, and the third about continuing care, sources of influence and functional health literacy. The six Midwestern participants included males and females, blacks and whites, rural and urban, and were interviewed during seven months starting September 2006. Concerns were diverse regarding health, social roles, and navigating a complex health care system. Current clinical concerns of the six persons included 1) extensive surgery for degenerative spinal disease, 2) the ongoing management of multiple chronic conditions including hypertension, hypercholesterolemia, pancreatitis, diabetes, and unexplained hypersensitivity in the feet, 3) sinus arrhythmia, psychosocial illness, and skin conditions, 4) casting and possible surgical correction for three fractures in the lower leg, 5) removal of mass in the throat, and 6) addiction recovery and inflammatory disease in the knee. Interview data was collected using video recordings. The interview dialogue data was typed into transcripts and Transana software linked time-marked transcripts to video data, thereby allowing the creation of video clips as part of initial coding. The video clips were used for further analysis, interpretation, and theme development to create narrative portraits of each participant. This paper narrows the findings of this research to discuss how each individual overcame demand side rationing. This paper concludes by posing discussion questions about how individuals may respond to new approaches to the rationing of scarce health care resources.