Access & Equity

How health care resources are distributed across the population and how access and health outcomes vary across different groups. LDI Senior Fellows focus on how to achieve greater access for vulnerable populations and how to reduce disparities in health outcomes.

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.

Racial/Ethnic Disparities in US Pediatric Growth Hormone Treatment

Adda Grimberg, MD
Sep. 13, 2018

Adda Grimberg, Anders Lindberg, Michael Wajnrajch, Andrew J. Cucchiara, Cecilia Camacho-Hübner

Abstract [from journal]

Background/Aims: To compare racial/ethnic proportions of subjects receiving growth hormone (GH) treatment to the expected proportions, and secondarily, to assess racial/ethnic differences in subject characteristics at GH treatment initiation. 

Methods: Race/ethnicity-based expected frequencies of height <–2.25 SD were determined by applying relative risks for short stature, calculated from a regional population of 189,280 pediatric primary care patients, to US census data, and compared to racial/...

Racial Disparities in Nephrology Consultation and Disease Progression among Veterans with CKD: An Observational Cohort Study

Peter P. Reese, MD, MSCE
Aug. 20, 2018

Jonathan Suarez, Jordana B. Cohen, Vishnu Potluri, Wei Yang, David E. Kaplan, Marina Serper, Siddharth P. Shah, ...

Abstract [from journal]

Background: Incident rates of ESRD are much higher among black and Hispanic patients than white patients. Access to nephrology care before progression to ESRD is associated with better clinical outcomes among patients with CKD. However, it is unknown whether black or Hispanic patients with CKD experience lower pre-ESRD nephrology consultation rates compared with their white counterparts,

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The ‘Warming Effect’ of DACA on American Children

Jun. 4, 2018

New research shows that young citizen children were more likely to receive important social services when their undocumented mothers became eligible for the Deferred Action for Childhood Arrivals (DACA) program. Providing evidence of the multi-generational spillover effects of immigration policy, this new analysis comes as the U.S.

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.

Being Uninsured in America

Apr. 26, 2018

For the nearly 30 million people in the United States who have no health insurance, gaining access to care and paying for that care can be a challenge.  A new “secret shopper” study explores whether the uninsured can get a new primary care appointment, and at what price.

‘Sharing things with people that I don’t even know’: Help-seeking for Psychological Symptoms in Injured Black Men in Philadelphia

Apr. 12, 2018

Sara Jacoby, John A. Rich, Jessica L. Webster, Therese S. Richmond

Abstract [from journal]

Objectives: Psychological distress is common in survivors of traumatic injury, yet across United States’ trauma systems, it is rare that standard injury care integrates psychological evaluation and professional...

County Jail or Psychiatric Hospital? Ethical Challenges in Correctional Mental Health Care

Mar. 27, 2018

Andrea G. Segal, Rosemary Frasso, Dominic A. Sisti

Abstract [from journal]

Approximately 20% of the roughly 2.5 million individuals incarcerated in the United States have a serious mental illness (SMI). As a result of their illnesses, these individuals are often more likely to commit a crime, end up incarcerated, and languish in correctional settings without appropriate treatment. The objective of the present study was to investigate how correctional facility personnel reconcile the ethical challenges that arise when housing and treating individuals with SMI. Four focus groups and one group interview were conducted with employees...

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