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.

The ‘Warming Effect’ of DACA on American Children

Jun. 4, 2018

New research shows that young citizen children were more likely to receive important social services when their undocumented mothers became eligible for the Deferred Action for Childhood Arrivals (DACA) program. Providing evidence of the multi-generational spillover effects of immigration policy, this new analysis comes as the U.S.

What State Legislators Say About Medicaid, and Why It Matters

May. 29, 2018

Medicaid’s federal-state partnership structure has long permitted states to adopt modifications to coverage design, including benefits and cost-sharing. That structure, combined with an Administration signaling its support for greater state flexibility and funding constraints, could produce substantial shifts in state Medicaid policy.

Being Uninsured in America

Apr. 26, 2018

For the nearly 30 million people in the United States who have no health insurance, gaining access to care and paying for that care can be a challenge.  A new “secret shopper” study explores whether the uninsured can get a new primary care appointment, and at what price.

‘Sharing things with people that I don’t even know’: Help-seeking for Psychological Symptoms in Injured Black Men in Philadelphia

Apr. 12, 2018

Sara Jacoby, John A. Rich, Jessica L. Webster, Therese S. Richmond

Abstract [from journal]

Objectives: Psychological distress is common in survivors of traumatic injury, yet across United States’ trauma systems, it is rare that standard injury care integrates psychological evaluation and professional...

County Jail or Psychiatric Hospital? Ethical Challenges in Correctional Mental Health Care

Mar. 27, 2018

Andrea G. Segal, Rosemary Frasso, Dominic A. Sisti

Abstract [from journal]

Approximately 20% of the roughly 2.5 million individuals incarcerated in the United States have a serious mental illness (SMI). As a result of their illnesses, these individuals are often more likely to commit a crime, end up incarcerated, and languish in correctional settings without appropriate treatment. The objective of the present study was to investigate how correctional facility personnel reconcile the ethical challenges that arise when housing and treating individuals with SMI. Four focus groups and one group interview were conducted with employees...

The Impact of AIDS Treatment on Savings and Human Capital Investment in Malawi

Feb. 21, 2018

Victoria Baranov and Hans-Peter Kohler

In American Economic Journal: Applied Economics, Hans-Peter Kohler and Victoria Baranov study the impact of antiretroviral therapy (ART), a treatment for AIDS, on savings and human capital investment in Malawi. In particular, they use spatial and temporal differences in ART availability to evaluate the impact of ART provision on cash savings, education expenditures, and children’s schooling.

The authors find that ART availability increases savings, expenditures on education, and children’s schooling significantly, even amongst those who are HIV-negative and thus, do not...

Integrating Social Needs Into Health Care: A Twenty-Year Case Study Of Adaptation And Diffusion

Feb. 14, 2018

Rebecca D. Onie, Risa Lavizzo-Mourey, Thomas H. Lee, James S. Marks, and Rocco J. Perla

In Health Affairs, Rebecca Onie and colleagues, including Risa Lavizzo-Mourey, conduct a twenty-year qualitative case study of Health Leads, an organization that partners with health care institutions and communities to address patients’ basic resource needs, and its funders. The case study demonstrates the successful stages of diffusion, defined as the process by which an innovation is communicated over time within a social system, leading to increased exposure and adoption. The authors segmented the process for Health Leads into five distinct phases:

  1. Testing and
  2. ...

Association of Rideshare-Based Transportation Services and Missed Primary Care Appointments: A Clinical Trial

Research Brief
Feb. 7, 2018

In a pragmatic trial, offering complimentary ridesharing services broadly to Medicaid patients did not reduce rates of missed primary care appointments. The uptake of free rides was low, and rates of missed appointments remained unchanged at 36%. Efforts to reduce missed appointments due to transportation barriers may require more targeted approaches.

Koh Promotes Partnerships at Penn 2018 Health Equity Symposium

Feb. 5, 2018

At Penn’s fourth annual Martin Luther King, Jr., Health Equity Symposium, keynote speaker Howard Koh, MD, MPH, former Assistant Secretary for Health for the U.S. Department of Health and Human Services (HHS), shared a motivating quote by Dr. King: “Life’s most persistent and urgent question is, ‘What are you doing for others?’”

Evaluating the association between the built environment and primary care access for new Medicaid enrollees in an urban environment using Walk and Transit Scores

Jan. 24, 2018

Krisda H. Chaiyachati, Jeffrey K. Hom, Rebecca A. Hubbard, Charlene Wong, and ...

In Preventive Medicine Reports, Krisda Chaiyachati and colleagues, including Jeffrey Hom and David Grande, describe the association between the quality of an individual’s built environment, as reflected by Walk Score™ (a measure of walkability to neighborhood resources) and Transit Score™ (a measure of transit access), with having a usual source of care among low-income adults in Philadelphia. They ascertained usual source of care (other than a hospital or emergency department) with the question: “Is there a particular doctor's office, clinic, health center, or other place that...

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