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.

Influence of provider mix and regulation on primary care services supplied to US patients

Oct. 15, 2015

Michael Richards, Daniel Polsky

In Health Economics, Policy and Law, Michael Richards and Daniel Polsky explore the link between provider mix and access for different patient types. The authors use data from a field study spanning 10 states where trained audit callers were randomly assigned an insurance status and then contacted primary care physician practices seeking new patient appointments. Clinics with more non-physician clinicians are associated with better access for Medicaid patients and lower prices for office visits. However, the authors only find this association in states granting full practice...

Financial toxicity in insured patients with multiple myeloma: a cross-sectional pilot study

Oct. 5, 2015

Scott Huntington, Brendan Weiss, Dan Vogl, Adam Cohen, Alfred Garfall, Patricia Mangan, Jalpa Doshi, Edward Stadtmauer

In Lancet Hematology, Scott Huntington and colleagues, including Jalpa Doshi, evaluate the financial toxicity of multiple myeloma treatment on insured patients. They conducted a cross-sectional survey of individuals receiving at least three months of ongoing treatment for multiple myeloma at a tertiary academic medical centre. The survey results show that  71% of the patients reported at least minor financial burden relating to their treatment and 36% reported needing to apply for financial assistance. The  authors conclude that additional attention to...

State Medicaid Spending on Sovaldi

Sep. 25, 2015

With a price tag of $1,000 per pill and $84,000 for a 12-week course of Sovaldi (sofosbuvir), Gilead Sciences prompted widespread concern about whether its new treatment for hepatitis C (HCV) would bankrupt public and private payers. These concerns were particularly significant for state Medicaid programs, which face both limited state budgets and high HCV prevalence among beneficiaries.

Asking the Patient About Patient-Centered Medical Homes: A Qualitative Analysis

Sep. 21, 2015

Jaya Aysola, Rachel M. Werner, Shimrit Keddem, Richard SoRelle, and Judy A. Shea

In the Journal of General Internal Medicine, Jaya Aysola and colleagues, including Rachel Werner and Judy Shea, assess patients’ perspectives of the patient-centered medical home (PCMH) model and compare responses by degree of practice-level PCMH adoption and patient race/ethnicity. The authors interviewed 48 patients with diabetes and/or hypertension enrolled in PCMHs within the University of Pennsylvania Health System. They purposively sampled minority and non-minority patients from the four highest-ranked and four lowest-ranked PCMH-adopting practices to determine whether...

Cultural Reflexivity in Health Research and Practice

Sep. 21, 2015

Robert Aronowitz, Andrew Deener, Danya Keene, Jason Schnittker, and Laura Tach

In the American Journal of Public Health, Robert Aronowitz and colleagues, including Jason Schnittker, argue that public health movements invoking cultural change to improve health and reduce health disparities have sometimes justified and maintained health inequalities. They argue that this happens when those with power and authority designate their own social practices as legitimate and healthy while labeling the practices of marginalized groups as illegitimate or unhealthy. This “misrecognition,” which creates seemingly objective knowledge without understanding historical and...

Elimination of cost-sharing and receipt of screening for colorectal and breast cancer

Sep. 17, 2015

Stacey A. Fedewa, Michael Goodman, W. Dana Flanders, Xuesong Han, Robert A. Smith, Elizabeth M. Ward, Chyke A. Doubeni, Ann Goding Sauer, Ahmedin Jemal

In Cancer, Stacey Fedewa and colleagues, including Chyke Doubeni, investigate whether the cost-sharing provision of the Affordable Care Act (ACA), which aimed to reduce financial barriers for preventive services, affected the prevalence of screening for certain cancers. The research looks specifically at the rates of screening for colorectal cancer and breast cancer among the privately insured and Medicare-enrolled adults of varying socioeconomic status (SES). It uses data from the National Health Interview Survey from 2008 and 2013. The authors find that the rate of screening for...

Impact of the Outpatient Clinic Experience on Retention in Care: Perspectives of HIV-Infected Patients and Their Providers

Sep. 10, 2015

Baligh R. Yehia, Aaloke Mody, Leslie Stewart, Carol W. Holtzman, Lisa M. Jacobs, Janet Hines, Karam Mounzer, Karen Glanz, Joshua P. Metlay, Judy Shea

In AIDS Patient Care and STDs, Baligh Yehia and colleagues, including Karen Glanz and Judy Shea, try to better understand patient and provider experiences with outpatient HIV clinics. Retention in care is critical to HIV treatment success. While previous research has shown that patient satisfaction with their HIV clinic strongly correlates with HIV outcomes, few have focused on evaluating the clinic experience. Yehia and colleagues invited a sample of patients with varying retention in care and viral suppression patterns to participate in qualitative, semi-structured interviews....

Geographic Barriers to Care: the Final Frontier?

Aug. 13, 2015

Although health reform has reduced many financial barriers to care, it has done little to overcome geographic barriers. Two recent studies by LDI Senior Fellows examine disparities in geographic access to specialty care in the United States, specifically gynecologic cancer care and comprehensive stroke treatment. They assess the potential impact of these disparities on health outcomes, and suggest population-based planning as a way to improve access to specialty care.

“Science has delivered solutions. The question for the world is: When will we put it into practice?”

Aug. 9, 2015

In the mid-eighties, I coordinated a medical genetics clinic at Johns Hopkins Hospital. We shared our outpatient unit, the Moore Clinic, with the AIDS Care Program, which began in 1984. Every week, I would see the devastating and shockingly rapid decline of robust young men—men my age—in the waiting room outside my office. I came to recognize the pattern:  two men would walk in, one weaker, one stronger.

Transforming Health, In Place

Jul. 8, 2015

As many of our blog readers know, LDI focuses on ways to improve our health care system. That’s our mission, and we’re sticking to it. But it’s worth remembering that some of the most powerful ways to improve health lie not in the health care system, but in strategies that directly change the places  people live, work, and play.

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