Access to Care

The extent to which someone can gain access to the health care system, and the financial, social, and organizational factors that affect a person’s ability to get needed care in a timely way.

Giving Patients a Ride: a Tricky Legal Line

Mar. 23, 2017

What if health systems provided rides for elderly patients with limited transportation options or poor patients unable to access public transportation? We might applaud them for a creative strategy to improve access for vulnerable populations. However, their actions might be illegal.

Pediatric and Adult Physician Networks in Affordable Care Act Marketplace Plans

Research Brief
Mar. 16, 2017

In a review of ACA plans, the authors find that the proportion of narrow networks were greater for pediatric specialties than for adult specialties, highlighting the need to monitor access to specialty care for children and families.

Primary Care Appointment Availability and the ACA Insurance Expansions

Issue Brief
Mar. 1, 2017

In the current debate in Congress over the Affordable Care Act (ACA), the issue of provider access is a major concern.Our 10-state audit study published in JAMA Internal Medicine finds that primary care appointment availability for new patients with Medicaid increased 5.4 percentage points between 2012 and 2016 and remained stable for patients with private coverage. Over the same period, both Medicaid patients and the privately insured experienced a one-day increase in median wait times. Higher appointment availability for Medicaid patients is a surprising result given the increase in demand for care from millions of new Medicaid enrollees. In this Issue Brief, we summarize our study’s findings, expand on possible explanations, and extend the analysis by examining the relationship between appointment availability and state-level Medicaid expansions. We find that access to primary care increased for Medicaid patients only in states that extended Medicaid eligibility to low-income, nonelderly adults. Combined, these results suggest coverage provisions in the ACA have not overwhelmed primary care capacity.

Price Transparency in Primary Care: Can Patients Learn About Costs When Scheduling an Appointment?

Feb. 16, 2017

Brendan Saloner, Lisa Clemens Cope, Katherine Hempstead, Karin Rhodes, Daniel Polsky, Genevieve Kenney

In the Journal of General Internal Medicine, Brendan Saloner, Daniel Polsky, Karin Rhodes, and colleagues investigate whether new patients can obtain price information for a primary care visit and identify variation across insurance types, offices and geographic areas. Cost-sharing in insurance plans incentivizes patients to shop for lower prices, but can patients obtain price information when scheduling office visits? The authors used a simulated patient methodology in which trained interviewers posed as patients (with different types of insurance) seeking new primary care...

Insurance Coverage and Access to Care Under the Affordable Care Act

Issue Brief
Dec. 8, 2016

This brief details changes in insurance coverage and access to care under the Affordable Care Act. About 20 million individuals gained coverage under the law and access to care improved.  Despite these gains, more than 27 million individuals are still uninsured, and many others face barriers in accessing care.  As a result of the 2016 elections, the future of the ACA is uncertain.  As the next Administration and policymakers debate further health system reforms, they should consider the scope of the ACA’s effects on their constituents. 

Health Systems and Social Determinants

Dec. 1, 2016

The election of Donald Trump has ushered in an uncertain future for the Affordable Care Act (ACA), from modification to total repeal. While many policy experts are concerned about people losing the coverage they gained through the ACA, other aspects of the ACA are also under threat: specifically, provisions that address the social determinants of health.

Deaths from Unintentional Injury, Homicide, and Suicide During or Within 1 Year of Pregnancy in Philadelphia

Oct. 14, 2016

Pooja K. Mehta, Marcus A. Bachhuber, Roy Hoffman, Sindhu K. Srinivas

In the American Journal of Public Health, Pooja Mehta and colleagues seek to understand the effect of unintentional injuries, suicide, and homicide on pregnancy-associated death. The authors find that about half of of pregnancy-associated deaths - occurring during or within one year of pregnancy - in Philadelphia between 2010 and 2014 were due to unintentional injuries, homicide, or suicide. Of these deaths, more than 50% were directly or indirectly associated with substance use, more than 40% were associated with serious mental illness, and more than 20% were associated with...

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