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.

Responding to the Trauma of COVID-19

Jul. 2, 2020

As the country looks to reopen and epidemiologists anticipate future waves of coronavirus (COVID-19) cases, we must address an equally important “pandemic:” the virus’ far-reaching mental health and trauma-related consequences. Whether balancing activities of essential work with exposure risk, bearing witness to suffering or loss, or feeling anguish or guilt for not “doing more” during this time, our society is facing great adversity with potentially devastating consequences.

Setting Standards for Affordable Health Care

Issue Brief
Jun. 16, 2020

In the run-up to the presidential election, the affordability of health care remains a top concern of the American voting public. But how do we know when health care is affordable? On a policy level, how do we set a standard for affordability that can be implemented in a reformed system? Sometimes policy debates about affordability focus only on whether insurance premiums are affordable, although consumers tend to be concerned about both premiums and out-of-pocket costs. At Penn LDI’s Medicare for All and Beyond conference, a panel of researchers, policy experts, and consumer advocates discussed and debated affordability in theory and practice. This issue brief summarizes the panel’s insights.

Pediatric Outpatient Utilization By Differing Medicaid Payment Models In The United States

Jun. 12, 2020

Therese L Canares, Ari Friedman, Jonathan Rodean, Rebecca R. Burns, Deena Berkowitz, Matt Hall, Elizabeth Alpern, Amanda Montalbano

Abstract [from journal]

Background: In the United States (US), Medicaid capitated managed care costs are controlled by optimizing patients' healthcare utilization. Adults in capitated plans utilize primary care providers (PCP) more than emergency departments (ED), compared to fee-for-service (FFS). Pediatric data are lacking. We aim to determine the association between US capitated and FFS Medicaid payment models and children's outpatient utilization.

Methods: This retrospective cohort compared outpatient utilization


Volume Of Frail Patients Predicts Outcome In Frail Patients After Cardiac Surgery

Nimesh Desai, MD, PhD
May. 4, 2020

Nicholas J. Goel, Amit Iyengar, John J. Kelly, Jason J. HanChase R. BrownNimesh D. Desai

Abstract [from journal]

Objective: Recent data from major noncardiac surgery suggest that outcomes in frail patients are better predicted by a hospital's volume of frail patients specifically, rather than overall surgical volume. We sought to evaluate this "frailty volume-frailty outcome relationship" in patients undergoing cardiac surgery.

Methods: We studied 72,818 frail patients undergoing coronary artery bypass grafting or valve replacement surgery from 2010 to 2014 using the Nationwide Readmissions Database.


Proportion of Racial Minority Patients and Patients With Low Socioeconomic Status Cared for by Physician Groups After Joining Accountable Care Organizations

May. 1, 2020

Jessica T. Lee, Daniel Polsky, Robert Fitzsimmons, Rachel M. Werner

Abstract [from journal]

Importance: The incentive structure of accountable care organizations (ACOs) may lead to participating physician groups selecting fewer vulnerable patients.

Objective: To test for changes in the percentage of racial minority patients and patients with low socioeconomic status cared for by physician groups after joining the ACO.

Design, Setting, and Participants: This retrospective cohort consisted of a 15% random sample of Medicare fee-for-service beneficiaries attributed to physician


Safe Start Community Health Worker Program: A Multisector Partnership to Improve Perinatal Outcomes Among Low-Income Pregnant Women With Chronic Health Conditions

Apr. 16, 2020

Shayna D. Cunningham, Valerie Riis, Laura Line, Melissa Patti, Melissa Bucher, Celeste Durnwald, Sindhu K. Srinivas 

Abstract [from journal]

Safe Start is a community health worker program representing a partnership between a high-volume, inner-city, hospital-based prenatal clinic; a community-based organization; a large Medicaid insurer; and a community behavioral health organization to improve perinatal outcomes among publicly insured pregnant women with chronic health conditions in Philadelphia, Pennsylvania. As of June 2019, 291 women participated in the program. Relative to a comparison group (n = 300), Safe Start participants demonstrate improved engagement in care, reduced antenatal


Food for Thought: A Qualitative Evaluation of Caregiver Preferences for Food Insecurity Screening and Resource Referral

Apr. 14, 2020

Danielle Cullen, Megan Attridge, Joel A. Fein

Abstract [from journal]

Background/Objective: Although there is growing interest in screening for Food Insecurity (FI) in the clinical setting, little research exists describing the effect of screening practices on caregiver comfort and willingness to disclose social risk, or what factors affect eventual engagement with food resources.

Methods: In this qualitative study, we conducted 40 semi-structured interviews with caregivers of pediatric patients who reported FI in the Emergency Department of an urban, freestanding children's


Survey-based Work System Assessment To Facilitate Large-scale Dissemination Of Healthcare Quality Improvement Programs

Apr. 9, 2020

Anping Xie, Danielle W Koontz, Annie Voskertchian, James C Fackler, Aaron M Milstone, Charlotte Z Woods-Hill

Abstract [from journal]

Introduction: The dissemination of quality improvement (QI) interventions to a broader range of healthcare settings requires a proactive assessment of local work systems and processes. The objective of this study was to examine the feasibility of using a survey-based work system assessment (WSA) tool to facilitate the dissemination of a program for optimizing blood culture (BC) use.

Methods: Informed by findings from an onsite, interview-based WSA at 2 hospitals, a 50-item WSA survey was devised and...

Medicaid Expansion’s Effects on Patients with Newly Diagnosed, Common Screenable Cancers

Feb. 24, 2020

In our study of nearly a million patients with newly diagnosed breast, colon, or lung cancer, the Affordable Care Act’s Medicaid expansion was associated with a decreased rate of uninsurance and a shift toward earlier-stage cancer diagnosis. Despite concerns that coverage expansions would result in longer wait times for treatment, my colleagues and I found no evidence that Medicaid expansion worsened access to timely cancer-directed therapies.