Online Program

Organizational values in the provision of access to care for the uninsured

Monday, November 4, 2013

Krista Harrison, PhD (c), Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Holly Taylor, PhD, MPH, Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Background: The Affordable Care Act will expand access to care for many, but not all, uninsured individuals. The need for safety net providers has not been eliminated. Health policy ethics scholars claim that a significant challenge in developing health policies is identifying the goals and values that frame them. However, no one to date has empirically documented the goals and values that that influence health policy in organizations that serve the uninsured; Community Access Programs (CAPs) provide an interesting laboratory in which to do so. CAPs are county-based efforts to provide cheap or free access to care for the uninsured; roughly 50 exist around the United States. Methods: The study employed comparative and qualitative case study methodology at two geographically diverse CAPs. Data collection methods included document review, observations, and key informant interviews with CAP staff, board members, and founders. Results: Nine organizational values were identified common to both sites: access to care, care quality, community wellbeing, decency, fairness, help people, member independence, organizational practice, and stewardship. Conclusions: Describing the organizational values at two CAPs increases transparency of the existing process. This study provides language for explicitly examining the relationship between organizational values and resource allocation decision processes in participating CAPs in the future. In the future, non-participating CAPs and other health care organizations such as accountable care organizations or consumer operated and oriented plans can facilitate discussions of their own values using the common language and definitions provided by this study.

Learning Areas:

Administration, management, leadership
Ethics, professional and legal requirements
Provision of health care to the public
Public health or related public policy
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Identify the characteristics of Community Access Programs that allow them to provide access to care for vulnerable populations. Define and describe the nine organizational values relevant to the formation and resource allocation decisions of two Community Access Programs. Discuss evidence-informed policy recommendations to increase the explicit discussion of organizational values in public health organizations and interventions.

Keyword(s): Access to Health Care, Ethics

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a doctoral candidate in the Bioethics and Health Policy track of the Department of Health Policy and Management at the Bloomberg School of Public Health; trained in empirical and conceptual health policy ethics methods. My interests include access to care for the uninsured, social justice, and resource allocation. My prior research has involved access to care for people with disabilities and evaluation of ethics in health care provision.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.