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.

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.

Eight Steps to Preventing Pregnancy-Related Mortality in Philadelphia

Jun. 30, 2015

A new report on maternal deaths in Philadelphia sheds light on a persistent problem and recommends concrete, doable steps to reduce pregnancy-related mortality. The 30 members of the Philadelphia Maternal Mortality Review (MMR) team, including LDI Senior Fellows Sindhu Srinivas and coauthor Pooja Mehta identified and reviewed all cases of Philadelphia residents who died within one year of the end of pregnancy from 2010-2012.

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.