Organizational values in the provision of access to care for the uninsured

Abstract

Background: For the last 20 years, health provider organizations have made efforts to align mission, values, and everyday practices to ensure high-quality, high-value, and ethical care. However, little attention has been paid to the organizational values and practices of community-based programs that organize and facilitate access to care for uninsured populations. This study aimed to identify and describe organizational values relevant to resource allocation and policy decisions that affect the services offered to members, using the case of community access programs: county-based programs that provide access to care for the uninsured working poor.

Methods: Comparative and qualitative case study methodology was used, including document review, observations, and key informant interviews, at two geographically diverse programs.

Results: Nine values were identified as relevant to decision making: stewardship, quality care, access to care, service to others, community well-being, member independence, organizational excellence, decency, and fairness. The way these values were deployed in resource allocation decisions that affected services offered to the uninsured are illustrated in one example per site.

Conclusions: This study addresses the previous dearth in the literature regarding an empirical description of organizational values employed in decision making of community organizations. To assess the transferability of the values identified, we compared our empirical results to prior empirical and conceptual work in the United States and internationally and found substantial alignment. Future studies can examine whether the identified organizational values are reflective of those at other health care organizations.

Keywords: bioethics; health policy empirical research; qualitative research; social science.