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.

Transportation and Medicaid: Breaking Through the Gridlock

Nov. 17, 2018

Lack of transportation has been an enduring barrier to care, especially for low-income and rural patients. Many of these patients are covered by Medicaid, which, since 1966, has provided non-emergency transportation (NEMT) to medical appointments for free or at a heavily subsidized rate. Although NEMT is built into the foundation of Medicaid, some state governments are seeking leeway to drop that benefit. The movement stems from persistent budget constraints and a view that NEMT is ineffective.

Reimagining Care to Support Families and Workers

Nov. 5, 2018

At some point in our lives, each of us will need care, or be asked to provide or arrange care for a loved one. Historically, we have relied on unpaid or poorly paid labor, largely delivered by women and minorities, to fill these needs; however, current arrangements are neither fair nor feasible.

Supply of Primary Care Providers and Appointment Availability for Philadelphia's Medicaid Population

Issue Brief
Oct. 23, 2018

This brief analyzes the supply of primary care providers serving the Medicaid population in Philadelphia, and the geographic variability of this measure across the city. It also examines important measures of access – appointment availability and wait time for an initial appointment – that highlight challenges faced by Medicaid patients.

Primary Care Access for Philadelphia’s Medicaid Population

Oct. 23, 2018

Following Medicaid expansion in Pennsylvania in 2015, more than one in five non-elderly adults in Philadelphia are now covered by Medicaid. This population faces unique challenges with accessing primary care, including fewer providers accepting Medicaid patients. 

Penn’s Gant Family Precision Medicine Consortium Takes on Sustainable Targeted Oncology

Sep. 20, 2018

Biomedical advances in genomics and oncology, combined with rising costs for targeted cancer therapies, challenge the way we currently deliver and pay for cancer care. To foster the economic sustainability of targeted therapies, the University of Pennsylvania convened the Gant Family Precision Cancer Medicine Consortium, a multidisciplinary work group of experts from health care economics, policy, law, regulation, biomedical research, patient advocacy, and the pharmaceutical and insurance industry.

Association of Pregnancy History and Cervical Cancer Screening in a Community Sample of Sexual Minority Women

Aug. 23, 2018

Madelyne Z. Greene,Tonda L. Hughes, Marilyn S. Sommers, Alexandra Hanlon, and Salimah H. Meghani

Abstract [from journal]

Background: Sexual minority women (SMW) face barriers to healthcare that may result in lower utilization of cervical cancer screening. Previous experiences with the healthcare system-specifically reproductive health-related encounters-have the potential to affect future use of screening services. This study aimed to examine the association between pregnancy history and cervical cancer screening in a diverse sample of SMW. Anderson's Behavioral Model of Health Services Use guided the selection of variables included in the study.

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Twelve-Month Outcomes After Transplant of Hepatitis C–Infected Kidneys Into Uninfected Recipients: A Single-Group Trial

Peter P. Reese, MD, MSCE
Aug. 13, 2018

Peter P. Reese, Peter L. Abt, Emily A. Blumberg, Vivianna M. Van Deerlin, Roy D. Bloom, Vishnu S. Potluri, Matthew Levine, Paige Porrett, Deirdre Sawinski, Susanna M. Nazarian, Ali Naji, Richard Hasz, Lawrence...

Abstract [from journal]

BackgroundOrgans from hepatitis C virus (HCV)–infected deceased donors are often discarded. Preliminary data from 2 small trials, including THINKER-1 (Transplanting Hepatitis C kidneys Into Negative KidnEy Recipients), suggested that HCV-infected kidneys could be safely transplanted into HCV-negative patients. However, intermediate-term data on quality of life and renal function are needed to counsel patients about risk....

Restricted Provider Choice in the ACA Marketplace

Aug. 8, 2018

On November 1st, the sixth year of open enrollment on the ACA Marketplace will start. While the basic rules that govern the Marketplace and the sliding-scale subsidies remain intact, gains in enrollment are unlikely given the end of penalties for the individual mandate, the emergence of association health plans, and new rules related to “short-term limited duration.”

Learning Your Alzheimer’s Risk: Implications for Long-Term Care Insurance

Jul. 25, 2018

In the not-too-distant future, individuals may be able to learn their risk of developing Alzheimer’s disease through biomarkers – measures of disease activity detected up to 20 years before symptoms present. This information would allow individuals (and their loved ones) to prepare for future cognitive and functional decline, but it also has implications for the purchase of private long-term care insurance.

Modernizing Medicare Funding for Nurse Education

Jun. 21, 2018

With policies rooted in the 1960s, it’s time to change how Medicare pays for nurse education. In a New England Journal of Medicine Perspective, LDI Senior Fellow Linda Aiken and colleagues present a compelling case for funding a new consortium model that trains nurse practitioners (NPs) in the community settings where they are a crucial source of primary care.

Measuring Emergency Care Survival: The Implications of Risk-Adjusting for Race and Poverty

Jun. 20, 2018

Kimon L.H. Ioannides, Avi Baehr, David N. Karp, Douglas J. Wiebe, Brendan G. Carr,...

ABSTRACT [FROM JOURNAL]

Objectives: We determined the impact of including race, ethnicity, and poverty in risk adjustment models for emergency care sensitive conditions mortality that could be used for hospital pay‐for‐performance initiatives. We hypothesized that adjusting for race, ethnicity, and poverty would bolster rankings for hospitals that cared for a disproportionate share of non‐white, Hispanic, or poor patients.

Methods: We performed a cross‐sectional analysis

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What State Legislators Say About Medicaid, and Why It Matters

May. 29, 2018

Medicaid’s federal-state partnership structure has long permitted states to adopt modifications to coverage design, including benefits and cost-sharing. That structure, combined with an Administration signaling its support for greater state flexibility and funding constraints, could produce substantial shifts in state Medicaid policy.

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