“Improving Native American elder access to and use of health care through effective health system navigation”

Abstract

BackgroundPublic insurance reforms of the past two decades have failed to substantively address the healthcare needs of American Indians in general, let alone the particular needs of American Indian elders, ages 55 years and older. Historically, this population is more likely to be uninsured and to suffer from greater morbidities, poorer health outcomes and quality of life, and lower life expectancies compared to all other United States aging populations, representing a neglected group within the healthcare system. Despite the pervasive belief that the Indian Health Service will address all their health-related needs, American Indian elders are negatively affected by gaps in insurance and lack of access to health care. While the 2010 Patient Protection and Affordable Care Act included provisions to ameliorate disparities for American Indians, its future is uncertain. In this context, American Indian elders with variable health literacy must navigate a complex and unstable healthcare system, regardless of where they seek care.MethodsThis community-driven study features a mixed-method, participatory design to examine help-seeking behavior and healthcare experiences of American Indian elders in New Mexico, in order to develop and evaluate a tailored intervention to enhance knowledge of, access to, and use of insurance and available services to reduce healthcare disparities. This study includes qualitative and quantitative interviews combined with concept mapping and focus groups with American Indian elders and other key stakeholders.DiscussionThe information gathered will generate new practical knowledge, grounded in actual perspectives of American Indian elders and other relevant stakeholders, to improve healthcare practices and policies for a population that has been largely excluded from national and state discussions of healthcare reform. Study data will inform development and evaluation of culturally tailored programming to enhance understanding and facilitate negotiation of the changing landscape of health care by American Indian elders. This work will fill a gap in research on public insurance initiatives, which do not typically focus on this population, and will offer a replicable model for enhancing the effects of such initiatives on other underserved groups affected by healthcare inequities.Trial registrationThis protocol does not include the collection of health outcome data. Clinicaltrials.gov, NCT03550404. Registered June 6, 2018.

Ethnic inequality within the elderly population in utilizing healthcare services

“…Walton & Anthony (2017) [5] found that while Latino, Black and Native American elderly individuals utilized less medical services than white peers, they expressed higher needs for utilization rates of medical services, even when other factors such as health needs, socio-economic levels or the medical systems’ features are accounted for. Similar minority ethnic groups also have a lower access to preventive medical services, intensive hospital care and advanced technological procedures [6, 7].…”

“…Nonetheless, universal health coverage is incapable of adequately addressing all of healthcare’s access inequities. Therefore, there is a need to assess the overall outcomes of the two ethnic populations, including mortality rates over time (not just within the specific hospitalization period following the trauma), functionality of the discharged patients, quality of life and/or unplanned readmissions that may indicate low quality hospital discharge processes [7, 9].…”

“…An essential measure in overcoming this challenge is to enhance health literacy at five levels: individual, family, organizational, community and policy-making [7, 18]. This entails strategic adoption of health literacy programs that encompass all ethnicities, considering their respective needs, norms and expectations.…”

Spatial accessibility assessment to healthcare facilities: urban and rural areas

“…Inequalities in healthcare cover several dimensions of service delivery, use of health care, health outcomes, reimbursement for health insurance and access, among others [1,2]. A key element that needs to be taken into account when examining geographical disparities at the end of life is how the accessibility of health services is influenced by the distance and the time it takes for people to reach them, as well as by the geographical distribution of healthcare providers and patients who benefit from their services.…”

Exercise-based interventions for Indigenous adults with chronic lung disease in Australia, Canada, New Zealand, and USA: a systematic review

“…Cultural safety is an Indigenous-led model of care that aims to redress power imbalances between health care providers and consumers, and in which clinicians undertake cultural self-reflection, bringing awareness to power relationships to decolonise and improve health practices (30). Indigenous peoples are less likely to access health care than non-Indigenous peoples for reasons including a lack of culturally safe services, low health literacy (31), living remotely and/or on reservations, and in some countries, due to inadequate health insurance coverage (32). When Indigenous peoples eventually utilise health care, they report additional barriers such as racism and receiving inappropriate care (33), leading to feelings of fear, distrust and alienation (34).…”