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.

Advancing LGBTQ Health – Hot topics on the national stage

Dec. 9, 2015

Although Section 1557 of the ACA may not be well known to the public, it took center stage at the recent Gay and Lesbian Medical Association (GLMA) annual conference in Portland, Oregon. The conference educates practitioners and students about the unique health needs of lesbian, gay, bisexual, transgender and queer (LBGTQ) individuals and families, and reports on the latest research on LGBTQ health. Here are some of the latest research and policy developments emerging from the conference.

Section 1557 of the ACA

Quality of Health Insurance Coverage and Access to Care for Children in Low-Income Families

Dec. 7, 2015

Amanda Kreider, Benjamin French, Jaya Aysola, Brendan Saloner, Kathleen Noonan, David Rubin

In JAMA Pediatrics, Amanda Kreider and colleagues, including Benjamin French, Jaya Aysola, Brendan Saloner, Kathleen Noonan and David Rubin, compare health care access, quality and cost outcomes by insurance type for children in low or moderate income households. Using family-reported measures from the National Surveys of Children’s Health, the authors examined children’s access to preventive and specialty care and caregiver satisfaction with insurance coverage, and also characterized unmet health needs and out-of-pocket costs over the last decade. The analysis revealed that...

A Tale of Two States: Do Consumers See Mental Health Insurance Parity When Shopping on State Exchanges?

Nov. 19, 2015

Kelsey Berry, Haiden Huskamp, Howard Goldman, Colleen Barry

In Psychiatric Services, Kelsey Berry and colleagues, including Colleen Barry, present an analysis of parity compliance in how behavioral health benefits are presented to consumers shopping on health insurance exchanges established by the Affordable Care Act.  All insurance plans sold on the exchanges are required to offer mental health and substance use disorder benefits in compliance with requirements of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA). The researchers reviewed summaries of benefits documents available to...

Cost Differences After Initial CT Colonography Versus Optical Colonoscopy in the Elderly

Nov. 19, 2015

Hanna Zafar, Jianing Yang, Katrina Armstrong, Peter Groeneveld

In Academic Radiology, Hanna Zafar and colleagues, including Peter Groeneveld, compare differences in total Medicare costs among asymptomatic elderly patients in the year after initial computed tomographic colonography (CTC) or initial optical colonoscopy (OC). In 2009, the Centers for Medicare and Medicaid Services stopped covering CTC screening among asymptomatic individuals based on the scarcity of data regarding differences in outcomes and costs between patients who received CTC and OC. Zafar and colleagues performed a retrospective cohort study of asymptomatic Medicare...

An Assessment of State-Led Reform of Long-Term Services and Supports

Nov. 16, 2015

Mary Naylor, Ellen Kutzman, Edward Miller, Pamela Nadash, Peter Fitzgerald

In the Journal of Health Politics, Policy and Law, Mary Naylor and colleagues evaluate the strategies used by state governments to improve long-term services and supports (LTSS) for adults with disabilities and functionally impaired older adults. Three strategies have been most commonly pursued by state governments to improve LTSS: expanding noninstitutioal care, integrating payment and care delivery, and realigning incentives through market-based reforms. Naylor and colleagues evaluate these strategies based on nine dimensions, including: ease of access, quality of care/life,...

“Sticker Shock” in Individual Insurance under Health Reform?

Nov. 9, 2015

Mark Pauly, Scott Harrington, Adam Leive

In 2013, before the ACA’s health insurance marketplaces opened, more than 10 million people purchased insurance in the individual market. In the American Journal of Health Economics, Mark Pauly, Scott Harrington, and Adam Leive estimate how the ACA affected the prices these buyers faced in 2014.  Before taking any federal subsidies into account, they find that the impact of the ACA on total average price was relatively modest.

They looked at the effects of the ACA on premiums, expected out-of-pocket payments, and total expected price paid by these former buyers. They...

Prevalence, Disparities, and Trends in Obesity and Severe Obesity Among Students in the School District of Philadelphia, Pennsylvania, 2006–2013

Nov. 5, 2015

Jessica Robbins, Giridhar Mallya, Amanda Wagner, James W. Buehler

In Preventing Chronic Disease, Jessica Robbins and colleagues, including Giridhar Mallya, examine the recent trends of childhood obesity in Philadelphia. The authors analyzed data from the School District of Philadelphia from 2006-2013 to assess trends in obesity and severe obesity among all children aged 5 to 18. They find significant declines in both the prevalence of obesity and severe obesity. Declines were larger among boys than girls, and among African Americans and Asians than among other groups. However, prevalence of obesity increased significantly among Hispanic girls...

Marital Status and Postoperative Functional Recovery

Nov. 5, 2015

Mark Neuman, Rachel Werner

In the JAMA Surgery, Mark Neuman and Rachel Werner explore the association between marital status and chances of survival after major surgery. The authors used data from the University of Michigan Health and Retirement Study, a longitudinal panel survey that enrolled adults 50 years of age or older. Among the adults included in these data, those who were divorced, separated or widowed had greater odds of dying or developing a new functional disability during the first two years after cardiac surgery compared with their married counterparts. These findings extend prior work...

Preterm Infant Attendance at Health Supervision Visits

Oct. 29, 2015

Jo Ann D’Agostino, Molly Passarella, Philip Saynisch, Ashley Martin, Michelle Macheras, Scott Lorch

In Pediatrics, Jo Ann D’Agostino and colleagues, including Scott Lorch, evaluate to what extent premature infants adhere to the American Academy of Pediatric’s (AAP) health supervision visit schedule, what factors affect adherence, and how adherence associates with receiving suggested preventive care. The AAP recommends periodic health supervision visits throughout childhood to monitor growth and development, and to screen for illnesses.  Using data from a 30-site primary care network, the authors find less than half of the infants received all expected health supervision visits....

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...

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