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.

Sizing Narrow Networks

Jun. 23, 2015

There’s been a lot of talk about "narrow" networks in ACA plans, which trade off limited provider coverage for lower premiums. Using a new integrated dataset of physician networks in plans on the federal and state marketplaces, our latest LDI/RWJF Data Brief describes the breadth of physician networks across all silver plans sold in 2014.

The Skinny on Narrow Networks in Health Insurance Marketplace Plans

Data Brief
Jun. 23, 2015

The Affordable Care Act (ACA) has prompted health plans to increase their use of “narrow networks” of providers as a cost containment strategy. The Leonard Davis Institute of Health Economics (LDI) has assembled the first integrated dataset of physician networks for the plans offered on the ACA marketplace. This data brief uses this new resource to describe the breadth of the physician networks in plans sold on the state and federal marketplaces. 

Fix Pennsylvania's Medicaid Policy on IUDs

Jun. 15, 2015

Cross-posted with the Philadelphia Inquirer

Imagine a woman in labor who goes to the hospital with a delivery plan she made in consultation with her obstetrician: yes to antibiotics in labor; no to an epidural for pain control; yes to neonatal circumcision; and yes to having an intrauterine device (IUD) placed immediately after childbirth.

Does Philadelphia Have Primary Care Deserts?

May. 19, 2015

Cross-posted with the Field Clinic blog

Over the past two years, one of the top health care priorities in Philadelphia has been getting people signed up for health insurance. That is still a huge, unfinished task, but alongside it we need to make sure we have enough doctors in the right places to deliver care. For health care reform to deliver on its promise, people need good access to primary care.

Priced out of primary care?

May. 4, 2015

Although the ACA has cut the level of uninsurance dramatically, roughly 30 million adults remain uninsured, many of them in states that did not expand Medicaid. Can these self-pay patients get an appointment with a primary care provider, and if so, at what price?

Neighborhood Social Environment and Patterns of Adherence to Oral Hypoglycemic Agents Among Patients With Type 2 Diabetes Mellitus

Apr. 1, 2015

Heather F. de Vries, McClintock, Douglas J. Wiebe, Alison J. O'Donnell, Knashawn H. Morales, Dylan S. Small, Hillary R. Bogner

In Family and Community Health, Heather F. de Vries and colleagues, including Douglas Wiebe and Dylan Small, examine whether social environment is related to adherence to oral hypoglycemic agents among patients with type 2 diabetes mellitus. While individual characteristics are important contributors to medication adherence, much of the observed variation in adherence rates remains unexplained by these factors De Vries and colleagues compare residents in neighborhoods with high social affluence, high residential stability, and high neighborhood advantage to residents of...

Understanding Low-Income African American Women's Expectations, Preferences, and Priorities in Prenatal Care

Apr. 1, 2015

Brownsyne Tucker Edmonds, Marjie Mogul, Judy Shea

In Family and Community Health, Judy Shea and colleagues seek to better understand low-income African-American women’s views on prenatal care. The analysis is the result a focus group study using a community-based participatory research framework. Shea and colleagues find that that friends/family and the baby’s health were the top factors that encouraged prenatal care attendance. Barriers to getting prenatal care included insurance, transportation, and ambivalence as to its importance. Facilitators included transportation services, social support, and education about available resources....

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...

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