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.

Health Care Safety-Net Programs After The Affordable Care Act

Issue Brief
Oct. 1, 2019

Prior to the Affordable Care Act (ACA), health care safety-net programs were the primary source of care for over 44 million uninsured people. While the ACA cut the number of uninsured substantially, about 30 million people remain uninsured, and many millions more are vulnerable to out-of-pocket costs beyond their resources. The need for the safety net remains, even as the distribution and types of need have shifted. This brief reviews the effects of the ACA on the funding and operation of safety-net institutions. It highlights the challenges and opportunities that health care reform presents to safety-net programs, and how they have adapted and evolved to continue to serve our most vulnerable residents.

Nonadherence Labeling in Primary Care: Bias by Race and Insurance Type for Adults With Type 2 Diabetes

Peter Cronholm, MD, MSCE
Sep. 24, 2019

Sourik Beltrán, Lanair A.Lett, Peter F.Cronholm

Abstract [from journal] 

Introduction: Little is known about how provider bias can influence nonadherence labeling. Therefore, a retrospective cohort analysis was conducted to assess the risk of patients with Type 2 diabetes being labeled nonadherent by sociodemographic factors.

Methods: Patients with Type 2 diabetes were identified from 4 primary care sites of the University of Pennsylvania Health System. Demographics, HbA1c, and ICD-10 codes for Type 2 diabetes and nonadherence were extracted from the electronic health


Fast-tracking Behavioral Health Care

Sep. 17, 2019

Imagine struggling with a behavioral health issue, searching for a local psychiatrist, and finding out the provider you’ve chosen doesn’t accept insurance. You wouldn’t be alone: most psychiatrists in the United States don’t. But let’s say your plan has some out-of-network benefits, which means you pay the full cost up front and request an itemized receipt for every appointment.

Associations Between Neighborhood Recreation Environments and Adolescent Physical Activity

Karen Glanz, PhD, MPH
Sep. 10, 2019

Kavita A. Gavand, Kelli L. Cain, Terry L. Conway, Brian E. Saelens, Lawrence D. Frank, Jacqueline Kerr, Karen Glanz, James F. Sallis

Abstract [from journal]

Background: To examine relations between parents' perceived neighborhood recreation environments and multiple measures of adolescent physical activity (PA).

Methods: Participants (N = 928; age 14.1 [1.4] y, 50.4% girls, and 33.4% nonwhite/Hispanic) and their parents were recruited. Teen moderate to vigorous PA (MVPA) was assessed with 7-day accelerometry. Self-reported total PA, PA near home, and PA at recreation locations were also assessed. Proximity of home to 8 types of recreation facilities was reported by


When Crises Converge: Hospital Visits Before And After Shelter Use Among Homeless New Yorkers

Sep. 3, 2019

Dan Treglia, Eileen L. Johns, Maryanne Schretzman, Jacob Berman, Dennis P. Culhane, David C. Lee, and Kelly M. Doran

Abstract [from journal]

People who are homeless use more hospital-based care than average, yet little is known about how hospital and shelter use are interrelated. We examined the timing of emergency department (ED) visits and hospitalizations relative to entry into and exit from New York City homeless shelters, using an analysis of linked health care and shelter administrative databases


Assessing the Relationship Between Housing and Health Among Medically Complex, Chronically Homeless Individuals Experiencing Frequent Hospital Use in the United States

Judy A. Shea, PhD
Sep. 2, 2019

Manik Chhabra, Emily Spector, Sophia Demuynck, Dawn Wiest, Laura Buckley, Judy A. Shea

Abstract [from journal]

In the United States and abroad, health systems have begun to address housing insecurity through programs that adhere to the Housing First model. The model provides permanent supportive housing without disqualification due to current mental health problems or substance use, along with optional case management services. This study used qualitative methods to explore how housing stability affected chronic disease management and social and community relationships among individuals with complex health and social needs and patterns of high hospital


Effect of Prices, Distribution Strategies, and Marketing on Demand for HIV Self-testing in Zimbabwe: A Randomized Clinical Trial

Aug. 28, 2019

Wei Chang, Primrose Matambanadzo, Albert Takaruza, Karin Hatzold, Frances M. Cowan, Euphemia Sibanda, Harsha Thirumurthy

Abstract [from journal]

Importance: HIV self-testing is a promising approach for increasing awareness of HIV status in sub-Saharan Africa, particularly in Zimbabwe, where HIV prevalence is 13%. Evidence is lacking, however, on the optimal pricing policies and delivery strategies for maximizing the effect of HIV self-testing.

Objective: To assess demand for HIV self-testing among adults and priority-population subgroups under alternative pricing and distribution strategies.

Design, Setting, and Participants:...

Benchmarking Treatment Effectiveness of Community-Delivered Trauma-Focused Cognitive Behavioral Therapy

Aug. 20, 2019

Brittany N. Rudd, Briana S. Last, Courtney Gregor, Kamilah Jackson, Steven Berkowitz, Arturo Zinny, Hilary E. Kratz, Lauren Cliggitt, Danielle R. Adams, Lucia M. Walsh, Rinad S. Beidas 

Abstract [from journal]

It is critical for urban youth with post-traumatic stress disorder (PTSD) living in poverty to have access to evidence-based interventions for their traumatic stress. However, there is limited research on the effectiveness of these interventions when provided in urban, community settings. The objectives of the current study are to (a) evaluate the effectiveness of trauma-focused cognitive behavioral therapy delivered from 2013 to 2016 in 15 behavioral health agencies on youth (N = 114) PTSD as well as  general mental health symptoms and  functioning,


Recognizing Racism in Medicine: A Student-Organized and Community-Engaged Health Professional Conference

Aug. 12, 2019

Ademide A. Adelekun, Sourik Beltrán, Julia Carney, Lanair A. LettWhitney U. Orji, Emily Rider-Longmaid, Daniel C. Stokes, Stephanie Teeple, and Jaya Aysola

Abstract [from journal]

Purpose: This piece details the evaluation and implementation of a student-led educational intervention designed to train health professionals on the impact of racism in health care and provide tools to mitigate it. In addition, this conference, cosponsored by medical, nursing, and social work training programs, facilitates development of networks of


Race, gender, and language concordance in the care of surgical patients: A systematic review

Jul. 30, 2019

Cindy Zhao, Phillip Dowzicky, Latesha Colbert, Sanford Roberts, Rachel R. Kelz

Abstract [from journal]

Background: No consensus exists on whether patient-provider race, gender, and language concordance provides benefits to surgical patients. We report a systematic review of the association between patient-provider concordance and patient preferences and outcomes in surgery.

Methods: A systematic review of the literature was performed in Medline and PubMed using defined search terms to identify studies related to patient-provider concordance in surgical patients. We included studies with full manuscripts published in