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.

Race/Ethnicity and Overuse of Care: A Systematic Review

Mar. 5, 2015

Nancy R. Kressin, Peter W. Groeneveld

In Milbank Quarterly, Peter Groeneveld and Nancy Kressin (Boston University) share their systematic review of the available literature on overuse of care and ethnicity. While many studies have looked at racial disparities in access to care, fewer have examined racial disparities in overuse of care. Analyzing 74 study outcomes (from 59 unique studies), the authors find that 32 outcomes indicate greater overuse by white patients, 9 find greater overuse by minorities, and 33 show no relationship between race and overuse of medical care. These results demonstrate that overuse of care is not...

Optimization Modeling to Maximize Population Access to Comprehensive Stroke Centers

Mar. 4, 2015

Michael T. Mullen, Charles C. Branas, Scott E. Kasner, Catherine Wolff, Justin C. Williams, Karen C. Albright, Brendan G. Carr

In Neurology, Michael Mullen, Charles Branas, Brendan Carr and colleagues share results of a virtual simulation focused on access to comprehensive stroke centers (CSCs), which are critical to ensuring access to stroke treatment. For their virtual trial, the authors selectively converted primary stroke centers (PSCs) to CSCs. Up to 20 PSCs per state were selected for conversion to CSCs, attempting to maximize the amount of the population with 60-minute CSC access by ground or air. Access was then compared across states. In 2010, the Joint Commission Survey found that 65.8 percent of the U.S...

Location of HIV Diagnosis Impacts Linkage to Medical Care

Mar. 1, 2015

Baligh R. Yehia, Elizabeth Ketner, Florence Momplaisir, Alisa J. Stephens-Shields, Nadia Dowshen, Michael G. Eberhart, Kathleen A. Brady

In the Journal of Acquired Immune Deficiency Syndromes, Baligh Yehia and colleagues investigate the importance of HIV diagnosis location for determining whether a person starts treatment in a timely manner. The U.S. National HIV/AIDS Strategy includes a goal to increase the proportion of persons linked to care within 3 months of diagnosis, which is critical to achieving HIV viral suppression. Baligh and colleagues analyze data on 1359 patients in Philadelphia newly diagnosed with HIV in 2010-2011. Diagnosis locations ranged from medical clinics and testing centers to inpatient settings and...

The Role of “Agent-Navigators” in ACA Marketplaces

Feb. 13, 2015

As the February 15 deadline for open enrollment on the ACA marketplaces approaches, surveys tells us that many uninsured people remain unaware or misinformed about whether they qualify for subsidies to help purchase health insurance. Prior to the ACA, many people looked to agents and brokers to understand their options and to help them find an individual plan.

Healthy Food Choice in the Inner City

Jan. 21, 2015

Two new studies challenge the assumption that simply building supermarkets in so-called ‘food deserts’ will yield nutritional and health benefits. These ‘deserts’ are geographic areas, usually urban and poor, that lack full-service grocery stores and fresh produce.

Bumped-up Medicaid Fees for Primary Care Linked to Improved Appointment Availability

Jan. 21, 2015

Did the two-year Medicaid “fee bump,” fully financed by the federal government, succeed in its goal of improving primary care availability for growing numbers of Medicaid patients? Most states, facing the decision of whether to use state funds to continue to pay for Medicaid primary care services at Medicare levels, were unconvinced, and Medicaid fees returned to previous levels in 34 states as of January 1, 2015.

Primary Care Appointment Availability and Preventive Care Utilization: Evidence From an Audit Study

Jan. 17, 2015

Brendan Saloner, Daniel Polsky, Ari Friedman, Karin Rhodes

In Medical Care Research and Review, Brendan Saloner (Johns Hopkins University), and Penn colleagues Dan Polsky, Ari Friedman and Karin Rhodes, analyzes adult preventive care utilization and primary care appointment availability. The authors link individual-level, cross-sectional data on adult preventive care utilization from the 2011-2012 Behavioral Risk Factor Surveillance System to novel county-level measures of primary care appointment availability collected from an experimental audit study conducted in 10 states in 2012 to 2013 and other county-level health service and...

The Affordable Care Act and Minority Health: Part IV (Workforce Diversity)

Jan. 15, 2015

As the Affordable Care Act’s health insurance marketplaces begin their second year of open enrollment, LDI examines the current and potential impact of the ACA on the health of minority populations. This fourth post of a five-part series describes the current initiatives to diversify the health care workforce with greater minority participation.

The Affordable Care Act and Minority Health: Part II (Medicaid)

Jan. 13, 2015

As the Affordable Care Act’s health insurance marketplaces begin their second year of open enrollment, LDI examines the current and potential impact of the ACA on the health of minority populations. This second post of a five-part series describes the benefits and shortfalls of the Medicaid expansion.

Appointment Availability after Increases in Medicaid Payments for Primary Care

Jan. 13, 2015

Daniel Polsky, Michael Richards, Simon Basseyn, Douglas Wissoker, Genevieve M. Kenney, Stephen Zuckerman and Karin V. Rhodes

In the New England Journal of Medicine, LDI Executive Director Dan Polsky and colleagues show that the increase in Medicaid reimbursement for primary care providers, a key provision of the Affordable Care Act (ACA), was associated with a 7.7 percentage point increase in new patient appointment availability without longer wait times. The results are from a new 10-state study and provide the first research-based evaluation of the association between the ACA’s two-year Medicaid fee bump — for which federal funding expired on December 31, 2014 — and appointment availability for...

The Affordable Care Act and Minority Health: Part I (Overview)

Jan. 12, 2015

As the Affordable Care Act’s health insurance marketplaces begin their second year of open enrollment, LDI examines the current and potential impact of the ACA on the health of minority populations. This first post of a five-part series describes the current state of insurance coverage and health disparities among racial and ethnic minorities.

The ACA’s Pediatric Essential Health Benefit Has Resulted In A State-By-State Patchwork Of Coverage With Exclusions

Jan. 10, 2015

Aimee M. Grace, Kathleen G. Noonan, Tina L. Cheng, Dorothy Miller, Brittany Verga, David Rubin and Sara Rosenbaum

In Health Affairs, Kathleen Noonan, co-director of the CHOP PolicyLab, and colleagues investigate how the Affordable Care Act’s (ACA) pediatric essential health benefit has been implemented by states. They look at how state benchmark plans - the base plan chosen in each state as the standard or benchmark of coverage in that state under ACA rules - address pediatric coverage in plans governed by the essential health benefits standard. The review of summaries of all the state benchmark plans found that no state specified a distinct pediatric services benefit class. Furthermore,...