East Tennessee older women’s perceptions of Medicare, Medicaid, and related health policies

Abstract

Older women face unique challenges regarding health disparities. This study aims to provide an understanding of older women’s perceptions and situated experiences regarding the gendered health disparities they face, which are characterized by the policies related to older women’s health and the geopolitical and social norms in which they live. The purpose of this project is to provide policy and decision-makers with insights and a better understanding of older women’s experiences and perceptions of the policies that impact their health and healthcare. The data for this study was collected through semi-structured interviews with twelve women in Appalachian East Tennessee. Areas examined include: the women’s perceived impact of federal, state, and local policies on the participants, particularly of Medicare and Medicaid; the role of social norming and health narratives, particularly stigmatization, discrimination, and health marginalization of older women; and the role of place and place-based drivers on these areas. This study sought to determine if these factors impact the participants’ awareness or lack of awareness of policies related to older women. Findings showed that older women in East Tennessee lacked knowledge of health policies, that older women perceive systemic and individual discrimination in policymaking, clinical care, and health research, and that they perceive that place-based drivers have impacted their access to healthcare. These findings have implications for policymaking and intervention design in co-production with older women in order to mitigate older women’s health disparities.

Keywords:

• Health disparities
• health policy
• Medicare
• Medicaid
• older women

Acknowledgements

Special thanks to Ms. Jamie Butler for her assistance in preparing the manuscript, Dr. Gerard McCartney, University of Glasgow, for his involvement in early versions, and the anonymous reviewers and editors for their helpful comments.

Ethical approval

The University of Tennessee, Knoxville Institutional Review Board approved the study in 2021 (UTK IRB-20-06193-XP) and all participants provided written informed consent.

Disclosure statement

No potential conflict of interests was reported by the author(s).

Data availability statement

The participants of this study did not give written consent for their data to be shared publicly. Therefore, due to the sensitive nature of this research, supporting data is not available.