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.

Health Inequity in the United States: A Primer

Issue Brief
Jan. 6, 2020

By any measure, the United States has a level of health inequity rarely seen among developed nations. The roots of this inequity are deep and complex, and are a function of differences in income, education, race and segregation, and place. In this primer, we provide an overview of these distinctly American problems, and discuss programs and policies that might promote greater health equity in the population. 

 

Medicare SNF Payment Policy: What a Difference a Day Makes

Dec. 19, 2019

It is hardly surprising that there’s a spike in the number of Medicare patients discharged from postacute care in a skilled nursing facility (SNF) the day before their copayment jumps from $0 to more than $150. However, the question remains whether this payment policy – which completely covers the first 20 days of a SNF stay – affects patient outcomes in any way.

Screening Instruments for Developmental and Behavioral Concerns in Pediatric Hispanic Populations in the United States: A Systematic Literature Review

Oct. 9, 2019

Stacey Bevan, Jianghong Liu, Kate Wallis, Jennifer Pinto-Martin

Abstract [from journal]

Background: Racial and ethnic disparities in the identification of developmental and behavioral concerns in children are public health problems in the United States. Early identification of developmental delay using validated screening instruments provides a pathway to prevention and intervention in pediatric health care settings. However, the validity of Spanish-language screening instruments, used in clinical settings in the...

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.

Racial and Ethnic Differences Over Time in Outcomes of Infants Born Less Than 30 Weeks' Gestation

Sep. 3, 2019

Nansi S. Boghossian, Marco Geraci, Scott A. Lorch, Ciaran S. Phibbs, Erika M. Edwards, Jeffrey D. Horbar

Abstract [from journal]

Objectives: To examine changes in care practices over time by race and ethnicity and whether the decrease in hospital mortality and severe morbidities has benefited infants of minority over infants of white mothers.

Methods: Infants 22 to 29 weeks’ gestation born between January 2006 and December 2017 at a Vermont Oxford Network center in the United States were studied. We examined mortality and morbidity rate differences and 95% confidence intervals for African American and

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#Shemergency: Use of a Professional Development Group to Promote Female Resident Recruitment and Retention

Aug. 27, 2019

Utsha Khatri, Jennifer Love, Amy Zeidan, Cindy Hsu, Angela Mills

Abstract [from journal]

Problem: Gender inequity in academic medicine is a pervasive challenge. Recommendations have been implemented to reduce inequities for female faculty. However, there are no well-established guidelines for the recruitment and retention of female residents.

Approach: To address challenges faced by female physicians and support the recruitment and retention of female residents, female emergency medicine residents and attending

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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

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