Surviving the American health care system: Experiences and strategies of uninsured women.

摘要

This qualitative study employs a materialist feminist theoretical perspective to examine women's experiences of pathways to loss of health care coverage and of seeking care and managing illness when uninsured. Forty-eight semi-structured interviews with women of diverse backgrounds, including a significant proportion of immigrant Mexicanas, were conducted and analyzed. More than three-quarters of those interviewed experienced untreated health problems. Pain, vulnerability, medical debt, and pressure from collection agencies were commonly reported experiences.; The interviews reveal that uninsured women seeking health care are cast in the role of supplicant, through repeated applications for General Assistance grants, complying with myriad and punitive Medicaid regulations, and borrowing money from relatives. Requests for assistance and penalties for medical debt accrued through emergency room visits forced women to assess whether a medical condition was worth seeking treatment. It was an assessment that had implications for their own worth as human beings, and many women felt the need to assert their humanity. For the immigrant women, denying health care assistance based on citizenship status was another indicator of the inhumanity of the system. Key areas for future research suggested by the experiences reported by the participants include the situation of workers who are disabled from working at jobs for which they have skills, but are unable to qualify for Social Security disability (and thereby excluded from both employment-based coverage and Medicaid); and overprescription of anti-depressants to poor, unemployed women. Many reported receiving (and some resisted) these in lieu of treatment and therapy, or material assistance.; This study demonstrates that there are numerous points in the American health care system where individuals are vulnerable to loss of coverage, that a fragmented system fosters resentment among various groups, and the necessity of a system that would provide coverage to all based on their ability to pay. It is argued that materialist feminism is an advantageous perspective for analyzing a health care system linked to paid employment due to its focus on women's paid and unpaid labor.