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What do Low-Income Californians Want?

Providers, plans, and politicians are working to ready the state’s healthcare system for the anticipated influx of new patients when 4.7 million Californians become eligible for Medi-Cal and subsidized coverage through the Exchange in 2014. But they have limited information about how this population currently uses care or wants to use it with new coverage.

To answer these questions, the Blue Shield Foundation surveyed over 1,000 low-income (less than 200% FPL) residents aged 19 to 64 about their healthcare usage, preferences, and plans for 2014. In the report of their findings, On the Cusp of Change, they found significant lack of choice and dissatisfaction with current care. While only 45% of those who rate their care now as good or excellent would be interested in switching to a new facility in 2014, nearly 7 in 10 of those who were less satisfied would switch.

While uninsured patients’ out-of-pocket costs will likely decrease when they gain coverage, cost was not the only or even the primary driver of patient opinions of care. Courtesy of staff, patient involvement, cleanliness, average time spent with a doctor, and having a personal doctor were the main predictors of patient satisfaction. Patients pointed to cost and seeing the same doctor at each visit, as well as convenience and ability to get an appointment, as key factors when seeking a new care location. Many prospective patients’ desires dovetail with the principles of the Patient-Centered Medical Home, which have been adopted by many counties, safety net hospitals, and clinics and endorsed by CPCA and CAPH.