Graduation Year

2017

Document Type

Thesis

Degree

M.A.

Degree Name

Master of Arts (M.A.)

Degree Granting Department

Anthropology

Major Professor

Heide Castaneda, Ph.D.

Committee Member

Roberta Baer, Ph.D.

Committee Member

Tara Deubel, Ph.D.

Committee Member

Jessica Mulligan, Ph.D.

Keywords

medical anthropology, health disparities, health policy

Abstract

Access to healthcare is an important topic within medical anthropology, in part because access is denied or complicated through structural forces for many populations in the United States. Anthropological research explores the impact of lack of access to healthcare on the lives of at-risk populations, as well as the differing and unexpected ways that access is denied or limited (Adler and Newman 2002; Becker 2004; Becker 2007; Horton 2004; Horton, McCloskey, Todd, and Henricksen 2001; O'Daniel 2008). For low-income, rural and minority populations, research shows that access to healthcare is further complicated by a higher propensity to break appointments (Bean and Talaga 1992; Bean and Talaga 1995). The act of appointment breaking is an essential aspect of this discussion: it is through appointment breaking and other similar activities that it is possible to understand how people access care when it is “available” to them and what everyday barriers prevent them from having true and full access. In this project, I define appointment breaking as the act of missing a scheduled appointment without prior cancellation.

Through this research, I explore how people understand their access to healthcare resources and what factors impact their use by focusing on appointment breaking at a Florida community health center. This research uses a critical medical anthropology approach and is grounded within the anthropological theories of access to healthcare, health disparities, structural violence, and the political economy of health; through this theoretical perspective, the issue of appointment breaking can be studied as a complex and integral aspect of access to healthcare, and rooted in the long history of medical anthropology studies on health disparities. Using qualitative research methods, specifically interviews and participant observation, as well as an analysis of the demographics of those patients that have missed appointments at this community health center, this study investigates the broader implications of a lack of access to care characterized by appointment breaking. This research connects the act of appointment breaking to cultural influences which shape access to healthcare. I found that barriers such as finances, mental health needs, personal issues, and lack of child care prevents patients from accessing healthcare, even through the safety net programs that are in place to serve at-risk populations, such as low income, rural, and minority populations. This research contributes to the existing literature on gaps in access to healthcare that is provided for at-risk populations and develops the anthropological research on the overlooked topic of appointment breaking. By exposing the issue of appointment breaking as a factor in the larger issues of access to care and health disparities, this research highlights the larger structural forces that impact access to care beyond access to insurance and the availability of affordable and accessible healthcare resources.

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