Improving the quality and cost-effectiveness of publicly financed health care
Helping Haitian Consumers Achieve Quality Health
With more than 60,000 members, the Haitian community is one of Boston's fastest growing immigrant populations. However, due to language barriers and cultural differences, Haitian patients often find navigating the health care system difficult. Through a $50,000 CHCS Consumer Action grant, Health Care for All and the Haitian Health Institute at Boston Medical Center (BMC) organized a consumer advisory board to uncover barriers to accessing care for Haitian consumers enrolled in the Boston Health Net plan at BMC.
"We thought consumers knew about using health care services, but we found that they truly did not understand the system," says Michele David, MD, MPH, MBA. "Typically they would call the clinic and ask to ‘make an appointment' when in fact they needed an urgent visit. As a result, they would get the next available appointment, which might be up to three months from the date of the call. They would end up at the emergency room for care because they couldn't wait for the appointment. But if they had told the clerk that they needed a sick visit appointment, depending on the urgency of the problem, they could be seen as soon as possible. Sometimes, they would even avoid care because they couldn't afford the co-pay, but would never think to ask to have it waived or to be billed later."
Responding to consumer needs, a workshop series covering topics such as "Emergency Room: When to Go and When Not to Go;" hospital logistics; patient bill of rights; and taking care of diabetes and asthma, was developed. There were 11 workshops, all of which were well attended. "This community is hungry for information," says Dr. David.
The Consumer Advisory Board met weekly to discuss access barriers and potential solutions. Once they had come up with a comprehensive list of suggestions, a select group of the Board met with hospital administrators. The meeting resulted in additional trilingual signage around the hospital, as well as a promise from administrators to review clinic evening hours and pharmacy co-pays. In addition, Health Care For All developed four public service announcements in Haitian Creole for television and two for radio that addressed diabetes care and asthma.
"Our goal was not only to help the consumer advisory board members understand how to use the system, but to send them out as ambassadors to teach their communities," says Dr. David. "They were so proud to be listened to and to see changes happen -- you could see it in their eyes how valuable the project was to them."