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Medical Care Research and Review
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66/1_suppl/75S    most recent
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Navigating Poorly Charted Territory

Patient Dilemmas in Health Care "Nonsystems"

Shoshanna Sofaer

Baruch College

American health care is complex, fragmented, and arcane rather than being patient centered. Many patients have considerable difficulty navigating this system. As a result, care is less timely, safe, effective, and efficient. Since navigation problems are more likely for those who are sicker and less educated, they contribute to inequity. Early solutions proposed for this problem focused on the use of yet another specialized professional, the "navigator," to help individuals find their way through the system so they get the care they need. The author defines the patient navigation problem and its probable consequences and argues that research and action are needed to (a) document the problem empirically, (b) identify underlying organizational structures and behaviors that can make navigation easy or difficult, and (c) assess whether and how policies, regulations, and improvement strategies can influence these structures and behaviors.

Key Words: consumer information • care coordination • consumer engagement • quality • patient-centered care

This version was published on February 1, 2009

Medical Care Research and Review, Vol. 66, No. 1 suppl, 75S-93S (2009)
DOI: 10.1177/1077558708327945
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