@article{d11f7f94c5b64963aa4361d889e91319,
title = "Administrative (in)Visibility of Patient Structural Vulnerability and the Hierarchy of Moral Distress among Health Care Staff",
abstract = "Public programs such as Medicaid offer highly circumscribed access to health care for low-income patients in the United States. This article describes the work of a variety of health care staff who manage specialized cancer care for publicly insured patients who have difficulty gaining or maintaining program eligibility or for uninsured and undocumented patients who are excluded from state programs. I highlight the moral distress that occurs when clinic employees become individually responsible for reconciling policies that limit patients{\textquoteright} access to care. I conclude that responsibility for securing access to cancer care for structurally vulnerable patients frequently falls to safety net clinics and that patients{\textquoteright} financial constraints are visible to particular types of staff, such as non-licensed health care staff and non-physician providers, who may experience moral distress disproportionately.",
keywords = "cancer, health policy, moral distress, public insurance, undocumented immigrants",
author = "Armin, {Julie S.}",
note = "Funding Information: This research was supported by a National Science Foundation, Doctoral Dissertation Research Improvement Grant, the Barbara Rosenblum Dissertation Scholarship from Sociologists for Women in Society, The Florence Hemley Schneider Prize in Women's Studies from Gender & Women's Studies at the University of Arizona, and a Dissertation Grant from the University of Arizona College of Social and Behavioral Sciences Research Institute. Thank you to Vincanne Adams, Victor Braitberg, Linda Green, Catherine Marshall, Mark Nichter, Susan Shaw, Jennifer Jo Thompson, Nicolas Rattray, and anonymous reviewers for reading and offering thoughts on versions of this article. I especially appreciate Mark Nichter's suggestion that I look to the nursing literature to better understand the implications of my research findings. Any errors are my own. Publisher Copyright: {\textcopyright} 2019 by the American Anthropological Association",
year = "2019",
month = jun,
doi = "10.1111/maq.12500",
language = "English (US)",
volume = "33",
pages = "191--206",
journal = "Medical anthropology quarterly",
issn = "0745-5194",
publisher = "John Wiley and Sons Inc.",
number = "2",
}