Journal Appraisal

BARRIERS TO HOMELESS PERSONS ACQUIRING HEALTH

INSURANCE THROUGH THE AFFORDABLE CARE ACT
Diajukan sebagai salah satu tugas dalam menjalani Kepaniteraan Klinik Senior
Bagian IKM / IKK Fakultas Kedokteran Universitas Syiah Kuala/
Rumah Sakit Umum Dr. Zainoel Abidin Banda Aceh

Disusun oleh :
ISNANIL HUSNA
1407101030154
Pembimbing:

dr. Rachmad Suhanda, M.Kes

BAGIAN ILMU KESEHATAN MASYARAKAT/

ILMU KEDOKTERAN KOMUNITAS
FAKULTAS KEDOKTERAN UNIVERSITAS SYIAH KUALA
RSUD Dr. ZAINOEL ABIDIN
BANDA ACEH
2016

BARRIERS TO HOMELESS PERSONS ACQUIRING HEALTH

INSURANCE THROUGH THE AFFORDABLE CARE ACT
Komponen
Judul

Hasil
Saran
Barriers to Homeless Persons Tidak
sesuai.
Acquiring Health Insurance Komponen

isi

Through the Affordable Care penelitian sudah jelas

Act

namun penelitian ini

tidak mencantumkan
tempat dan tanggal

Abstrak

penelitian.
Medicaid expansion under Tidak sesuai. Abstrak
the Affordable Care Act pada

penelitian

ini

(ACA) is intended to provide melebihi syarat, yaitu

a framework for increasing maksimal 200 kata.
health

care

access

vulnerable

for Dimana

pada

populations, penelitian ini abstrak

including the 1.2 million terdiri dari 291 kata.

who

experience

homelessness each year in

the United States. Objective:
We sought
to

characterize

homeless

persons knowledge of the

ACA, identify barriers to
their ACA enrollment, and
determine access to various
forms of communication that
could be used to facilitate
enrollment. Methods: At an
urban county. Level I trauma
center, we interviewed all
noncritically ill adults who

presented to the emergency

department

(ED)

during

daytime hours and were able

to

provide

consent.

assessed

access

communication,

We
to

awareness

of the ACA, insurance status,

and

barriers

preventing

subjects from enrolling in

health

insurance

and

compared homeless persons

responses

with

concomitantly

enrolled

housed individuals. Results:

Of the 650 enrolled subjects,
134 (20.2%) were homeless.
Homeless

subjects

were

more likely to have never

heard of the ACA (26% vs.
10%). Not being aware
if they qualify for Medicaid
was the most common (70%)
and most significant (30%)
barrier

to

enrollment

reported
by

uninsured

persons.

Of

homeless
homeless

subjects who
were unsure if they qualified
for Medicaid, 91% reported
an income < 138% of the
federal poverty level, likely

qualifying

them

for

enrollment. Although 99% of

housed

subjects

reported

access to either phone or

internet,

only

74%

of

homeless subjects reported

access.
Conclusions:

Homeless

persons report having less

knowledge of the ACA than
their

housed counterparts,

poor understanding of ACA

qualification

criteria,

and

limited access to phone and

internet. ED-based outreach
and

education

regarding

ACA eligibility may increase

their

enrollment.

2015

Elsevier Inc.
,Keywordsemergency
medicine;

emergency

department; homeless; health

insurance; Affordable Care
Act; ACA; access to care;
uninsured;
managed

underinsured;
care;

health

systems; health disparities;

health
Desain Penelitian

policy;

Medicare;

utilization
Analitik
dengan
sectional

cross

Sesuai. Penelitian ini

menggunakan metode
cross sectional dan
sesuai dengan tujuan

Tempat

dan

Waktu Penelitian dilakukan di San

Penelitian

Francisco General Hospital

pada

Sampel Penelitian

penelitian.
Sesuai

bulan

Juni

Agustus 2014
Sampel diambil

sampai
dengan Sesuai. Pengambilan

menggunakan

teknik sampel penelitian ini

Purposive sampling. Sampel cocok menggunakan

berjumlah

650

responden teknik

purposive

yang merupakan pasien di sampling,

Instalasi Gawat Darurat.

dimana

pengambilan sampel
didasarkan pada suatu
pertimbangan tertentu
yang

dibuat

peneliti

oleh
sendiri,

berdasarkan ciri atau

sifat-sifat

populasi

yang tidak diketahui

sebelumnya.
Sesuai. Penelitian ini

Skala dan Jumlah

a. Variabel independen

- Komunikasi, Kepedulian hanya

terhadap

b. Variabel dependen

ACA,

mencari

Status korelasi

antara

Asuransi,

variabel

baik

- Pengetahuan orang miskin

independen

dan

dependen

dan

Uji Statistik

mencari korelasi.
Analisa Bivariat, Univariat, Sesuai

Hasil

dan Multivariat.
Most homeless persons in

Sesuai, tapi lebih baik

this ED had some type of

untuk mencantumkan

health insurance, but they

jumlah

reported

didapatkan

having

less

yang
dalam

knowledge of the ACA than

bentuk angka yang

their housed counterparts.

dapat

mencakup

Most homeless subjects who

keseluruhan

do not have health insurance

penelitian.

report major barriers to

enrollment, especially lack of
information

and

understanding

poor

of

enrollment

the

process.

Homeless persons were less

likely to have access to
standard

forms

of

communication (phones and

computers) and, therefore,
face-to-face enrollment may
be the only way to boost
their

enrollment.

Overall,

our findings suggest that

homeless
benefit
outreach

patients
from
and

could

enrollment
education

regarding

Medicaid

eligibility

during

presentations to the ED.

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