This thesis examines how a Patient-Centered Medical Home addresses, implements, and provides medical and social resources and services within the Florida U.S. safety-net system, and how patients and providers perceive health care interactions between each other. The safety-net clinics seek to fill the care gap for millions of uninsured low-income U.S. residents who cannot afford private insurance, are unemployed, self-employed, undocumented, or their low income exceeds the qualification threshold, and they face barriers in accessing expensive medical care in the U.S. I have conducted ethnographic research at Grace Medical Home, a safety-net clinic in Central Florida, which included five months of primary data collection via participant observation, informal interviews, and 22 semi-structured interviews with healthcare providers, volunteers, and patients. My secondary data analysis focused on health policies and guidelines. Based on the study findings, I argue that safety-net clinics are vital in addressing health care gaps for the uninsured, and are in the position to provide comprehensive services by integrating social care (e.g., transportation, housing, food) together with medical services, including mental healthcare. The generative labor approaches evident at my research site are valuable in mitigating structural vulnerabilities and remaining barriers in the delivery of social care. An example of generative labor of healthcare providers is assisting a patient that is applying for the prescription application program (PAP) which provides free medications to patients for a year. This can be a complicated process but the assistance from a healthcare provider mitigates these complexities by utilizing the provider's expertise of the PAP process. However, the safety-net clinics must navigate complicated and challenging state and government policies. The interview narratives also show that care is conceptualized beyond medical and social needs, with the goal of restoring dignity in care, fostering relationships, and offering Christ-centered, non-judgmental care. In my discussion, I apply critical medical anthropology approaches through an analysis of the health care structures, health inequalities, and the political economy of health care for vulnerable people. This study is significant to anthropology and public health because it demonstrates the implementation of integrative, comprehensive medical and social care in addressing social determinants of health within the Florida safety-net system. It also advances our understanding of the way care is conceptualized at a faith-based safety-net clinic. As patient-centered care is becoming the gold standard in recent decades, this study also contributes an ethnographic analysis of how a safety net clinic achieves the goal of providing this form of care.
| Identifer | oai:union.ndltd.org:ucf.edu/oai:stars.library.ucf.edu:etd2020-2843 |
| Date | 15 August 2023 |
| Creators | Devaney, Jacqueline |
| Publisher | STARS |
| Source Sets | University of Central Florida |
| Language | English |
| Detected Language | English |
| Type | text |
| Format | application/pdf |
| Source | Electronic Theses and Dissertations, 2020- |
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