Table 1.

ThemeDescription and Number of Study Participants Mentioning Theme by Enrollment StatusSubjects’ Comments
1. No Need When HealthySubjects did not understand why they needed to be enrolled in the plan during times when they were well.“I haven’t re-enrolled yet because I haven’t had a need to see a doctor and your payment is based on the time you see the doctor for a 6-month period, so if I don’t need to see a doctor for 6 months, then that money would be toward nothing, so to speak.”
Mentioned by:“It's like buying insurance; you pay the money and, if you never need the insurance, it's money wasted. But if you need it, it is money well spent.”
Re-enrolled participants: 8“Had I been going to the doctor and had I been more healthy, you know, in a healthy state, I probably would be less likely to sign up for it, you know, for the 6-month commitment.”
Not enrolled participants: 8
2. Personal AgencySubjects expressed varying levels of willingness to assume personal responsibility regarding their enrollment and re-enrollment in the program.“I screwed the pooch on that one and failed to get my application in on time.”
Mentioned by:“Nobody's actually really followed up to find out why I didn’t fill out the forms or did I receive the forms or whatever. So it kinda's just the fact that it's been left sitting, and I keep getting a bill every month, so I don’t understand why nobody is following up to ask me what's going on.”
Re-enrolled participants: 7“This is one of those things that's been frustrating for me, watching the health care debate evolve around us and nobody's asking people like me who’ve been on that edge between insured and uninsured and, you know, what do we want?”
Not enrolled participants: 7
3. No ChoiceSubjects reported they were not able to access health care as an uninsured person unless they joined a program like Access Assured.“I really don’t have a choice at this point because I need to continue to get my medications refilled so…even if I got a job tomorrow, it would still be 3 months before my insurance would kick in, you know, so I do have to come up with the money and go back on the program so that I can continue my health care.”
Mentioned by:“Yeah, I’m gonna really have no choice because I love my doctor.”
Re-enrolled participants: 9
Not enrolled participants: 8
4. ContinuitySubjects expressed strong loyalty to their own provider and had varied views on the role Access Assured played in facilitating that relationship.“I don’t think being in the Access Assured program has any direct relevance to my health. I would still call my PCP if I needed to be seen. If not, then I would go to urgent care, so…and then probably, you know, follow-up in the office. So, eventually, I would get the care, you know, at the office level but I don’t think that it necessarily keeps me or, you know, ensures that I’m gonna go there or not go there if I had the choice.”
Mentioned by:“If a person is a couple days late with their payment, please don’t cancel them completely and take away their ability to see their doctor again, you know. I guess it all comes really down to again that we wouldn’t be enjoying this program unless we weren’t up against the wall anyway.”
Re-enrolled participants: 7“[My enrollment period] has run out and they won’t let me get a prescription through my doctor or even talk to a nurse or anything until I renew that, and I’ve been seeing this doctor for over 14 years. And I just, I just disagree on that. I just don’t think that's right.”
Not enrolled participants: 5“I live clear out on 122nd in SE [Portland] and, umm, no matter where I’ve lived, I’ve always gone to see Dr. W. or Dr. B., even though I’ve gotta take more buses to get there. I’d rather go where I know the doctors and they’re good to me and they understand chronic pain.”
5. RespectSubjects expressed gratification for the appearance of consistent medical care between uninsured and insured patients.“I was treated very well. They still don’t, you know—they didn’t change their medical practices because I was uninsured…a huge relief! Because a lot of doctors do that…outside of OHSU—but they still treated me just like any other patient.”
Mentioned by:“They’re doing much better now than they were when I first started, you know, but when I first started, and the program first came out, I felt like I was treated, umm, differently amongst normal patients. You know like, umm—I just—maybe, like I was a disease or something.”
Re-enrolled participants: 5
Not enrolled participants: 4
6. AppreciationSubjects expressed appreciation for the program and were grateful to have access to care.“Before I see them my count of diabetes wasn’t that good and practically I was fully blind—I could not drive—and everything is come down, I can see 20/20 now and I appreciated the doctor who did this service to me. My diabetes came down and I realize what kind of food I have to eat to come down my diabetes to stay in the same number.”
Mentioned by:“Well, I—I’ve lost a significant amount of weight and I stopped drinking so, umm, that's kind of on the personal side, but, yeah, I’ve definitely improved in my health.”
Re-enrolled participants: 11“For the most part it makes me feel comfortable! I have access! I have access to medical! I have access to medical care without having to worry about money… You know $350 is a lot better than$1500 or so, you know?”
Not enrolled participants: 10“It's a marvelous service to have for people who don’t have full-on insurance and there's a lot of us. So, I’m just really grateful that it's available.”
7. Quality of CareSubjects had both negative and positive comments about the quality of care and services received.“I was completely hopeless that I didn’t have a doctor and I didn’t have anybody to listen to me or take care of me, so when I joined OHSU, and then I was relieved emotionally that I am in the hands of a professional and caring people, that when I am sick there was somewhere to go and some people nice…to help me.”
Mentioned by:“The people were extremely courteous. Extremely nice. Things moved along. Actually when you went there wasn’t much of a wait. Just the staff in general made you feel comfortable. Even the doctor. Just basically I like the people but it seemed easier to go right down to the bottom…to deal with folks. It just seemed like their attitudes were better or something. I don’t quite know how to put my finger on that.”
Re-enrolled participants: 17“It's much nicer if you can sit and speak to a doctor instead of…talking to them while they’re typing into a machine.”
Not enrolled participants: 16
8. Confusion and TransparencySubjects reported confusion about the terms of the program, including a lack of understanding of their enrollment periods, benefits, and sliding scale fees depending on their income.“I thought this $150 every 6 months was automatic based on the period of our application for OHSU financial assistance. I never requested Access Assured; it was all just like—it all ran together.” Mentioned by:“It's possible that they gave me the information but, like I said, I was so sick at the time. I just needed to be seen so, I mean, that's what I did. I signed the paper so that I could be seen. I didn’t read it very well. It might have been in the information. I don’t know.” Re-enrolled participants: 8“They directed me to other people who thought they could tell me what was covered and then those people didn’t know and directed me somewhere else and it turned out nobody really knew. That's what should change.” Not enrolled participants: 10 9. Economic StressSubjects reported a wide range of personal and family economic stress, including job loss, debt, and the high cost of health care to them personally.“It was still too expensive for low-income people, but at least it was something.” Mentioned by:“We cannot predict the future and the costs of medical has gone completely out of sight. Absolutely ridiculous. And if one gets sick, you’re certainly in debt for the rest of your life—and your family after that to pay off your medical bills.” Re-enrolled participants: 18“Coming up with$75 is hard enough, but coming up with \$150 is just scary. It means food or not. I mean, it's scary.”
Not enrolled participants: 20“Yeah, I was a Union Sheet Metal journeyman for like 13, 14 years; had Blue Cross Blue Shield and, uh, I never got sick and I never used it once. Yeah…and then I had the Oregon Health Plan (Medicaid) after that, umm…and then I made too much money at minimum wage and I basically was without health care at all and I had the stroke without health care; that's why I didn’t go to the hospital.”
“I was a student at Portland State, and I, uh, I had a hernia erupt… My plan was to drop out of school, get a job, and get health insurance so I could get covered and last year simply was not a good year and I’ve been several months between contracts. I’m in software, [information technology], computer programming, that sort of thing, so it is a lot of contract work for people starting out. And, again, uh, you know, here's your 2- or 3-month contract and it's 90 days before you can get health insurance and that sort of thing.”
• OHSU, Oregon Health & Science University.