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.

Association of Rideshare-Based Transportation Services and Missed Primary Care Appointments: A Clinical Trial

Research Brief
Feb. 7, 2018

In a pragmatic trial, offering complimentary ridesharing services broadly to Medicaid patients did not reduce rates of missed primary care appointments. The uptake of free rides was low, and rates of missed appointments remained unchanged at 36%. Efforts to reduce missed appointments due to transportation barriers may require more targeted approaches.

Evaluating the association between the built environment and primary care access for new Medicaid enrollees in an urban environment using Walk and Transit Scores

Jan. 24, 2018

Krisda H. Chaiyachati, Jeffrey K. Hom, Rebecca A. Hubbard, Charlene Wong, and ...

In Preventive Medicine Reports, Krisda Chaiyachati and colleagues, including Jeffrey Hom and David Grande, describe the association between the quality of an individual’s built environment, as reflected by Walk Score™ (a measure of walkability to neighborhood resources) and Transit Score™ (a measure of transit access), with having a usual source of care among low-income adults in Philadelphia. They ascertained usual source of care (other than a hospital or emergency department) with the question: “Is there a particular doctor's office, clinic, health center, or other place that...

Association of Patient Out-of-Pocket Costs With Prescription Abandonment and Delay in Fills of Novel Oral Anticancer Agents

Research Brief
Jan. 19, 2018

High out-of-pocket (OOP) costs may limit access to novel oral cancer medications. In a retrospective study, nearly one third of patients whose OOP costs were $100 to $500 and nearly half of patients whose OOP costs were more than $2,000 failed to pick up their new prescription for an oral cancer medication, compared to 10% of patients who were required to pay less than $10 at the time of purchase. Delays in picking up prescriptions were also more frequent among patients facing higher OOP costs. 

Networks in ACA Marketplaces are Narrower for Mental Health Care Than for Primary Care

Research Brief
Sep. 5, 2017

In 2016, ACA marketplace plans offered provider networks that were far narrower for mental health care than for primary care. On average, plan networks included 24 percent of all primary care providers and 11 percent of all mental health care providers in a given market. Just 43 percent of psychiatrists and 19 percent of nonphysician mental health providers participate in any network. These findings raise important questions about network sufficiency, consumer choice, and access to mental health care in marketplace plans.

Progressive rural-urban disparity in acute stroke care

Aug. 29, 2017

Sergio Gonzales, Michael T. Mullen, Leslie Skolarus, Dylan P. Thibault, Uduak Udoeyo, and Allison W. WIllis

In Neurology, Sergio Gonzales and colleagues, including Michael Mullen and Allison Willis, examine differences in tissue plasminogen activator (tPA) utilization between rural and urban stroke patients. As with many health services, disparities in care based on geographic location or income exist, and rural populations often have little access to medical care. The authors used ten years of hospital discharge data from the National Inpatient Sample and indicators of tPA utilization for acute strokes. They find that, of 914,500 cases, tPA use in urban hospitals was quadruple that of...

Community Health Worker Support For Disadvantaged Patients With Multiple Chronic Diseases: A Randomized Clinical Trial

Research Brief
Aug. 21, 2017

Community health worker interventions hold promise for improving outcomes of low-income patients with multiple chronic diseases.

Chart of the Day: Adverse Tiering for HIV/AIDS Patients

Aug. 3, 2017

It’s called “adverse tiering” and it’s a benefit strategy designed to dissuade patients with expensive chronic conditions from enrolling in marketplace plans. The ACA prohibited plans from refusing to cover patients with pre-existing conditions and from charging them higher premiums. To avoid high-cost patients, some plans have structured their formularies to require substantial cost sharing for drugs in a certain class, particularly for expensive conditions such as HIV/AIDS.

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