A study of women prisoners' use of co-payments for health care: issues of access.

OBJECTIVES We sought to analyze women prisoners' use of co-payments for health care; how co-payments affect their access to health care; and how they view the impact of co-payments on their health. METHODS Using a community-based participatory research approach, we conducted six focus groups with 31 previously incarcerated women. Data were analyzed using qualitative field research methods, grounded theory, and consensual qualitative research strategies to construct a shared understanding of the data. RESULTS Co-payments hindered women prisoners' access to health care. Women reported inequitable implementation of the policy and foregoing care because of the financial burden of the co-payment. Co-payments contributed to delays in treatment, avoidance of health care professionals, unnecessary suffering, and poor health outcomes. In response, women used self-advocacy skills to manage their health care needs and deal with the prison health care system. CONCLUSION Co-payments place an unfair burden on prisoners who are poor, limit access to health care, and contribute to needless suffering and potentially to preventable deaths.