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.

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...

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...

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