Publications on Access to Health Care
Access to health care usually refers to the ease with which an individual can gain entry to or receive needed medical services. RAND research addresses multiple dimensions of access, including: financial access, usually facilitated through health insurance; potential access, usually aided by having a regular health care provider; and realized access, when an individual actually receives needed medical care. Many RAND studies have also examined disparities in access across different population groups and the effect of disparities on health.
Selected Publications, 2007 to Present
2010
Ease Medicaid/SCHIP Eligibility Rules — January 8, 2010
This document explores how expanding Medicaid/SCHIP eligibility would affect health system performance along nine dimensions.
The Effects of the Affordable Care Act on Workers' Health Insurance Coverage — September 1, 2010
The nature of employer-sponsored coverage may change substantially after implementation of the Patient Protection and Affordable Care Act, with an increase in the number of workers offered coverage through the health insurance exchanges.
Establishing State Health Insurance Exchanges: Implications for Health Insurance Enrollment, Spending, and Small Businesses — August 11, 2010
The Patient Protection and Affordable Care Act will increase insurance offer rates at small businesses. By 2016, rates would increase from 53 to 77 percent at firms with ten or fewer workers and from 71 to 90 percent at firms with 11 to 25 workers.
Health Care on Aisle 7: The Growing Phenomenon of Retail Clinics — June 8, 2010
Presents information on the growing phenomenon of retail medical clinics, the types of patients they serve and the types of care they provide, and whether some common claims about retail clinics are supported by evidence.
Increase the Use of "Bundled" Payment Approaches — January 8, 2010
This document explores how increased use of bundled payment approaches would affect health system performance along nine dimensions.
Modify Federal Tax Code to Create Incentives for Individuals to Obtain Coverage — January 8, 2010
This document explores how a refundable tax credit to offset the cost of health insurance premiums would affect health system performance along nine dimensions.
Post-Katrina Project Demonstrates a Rapid, Participatory Assessment of Health Care and Develops a Partnership for Post-Disaster Recovery in New Orleans — March 10, 2010
Stakeholders in communities in which health care access was disrupted by Hurricane Katrina were engaged in an assessment of health priorities, as well as in data interpretation and plan design, to produce a sustainable community-academic partnership.
Require Employers to Offer Coverage — January 8, 2010
This document explores how requiring employers to offer health insurance (an employer mandate) would affect health system performance along nine dimensions.
Require Individuals to Obtain Coverage — January 8, 2010
This document explores how requiring individuals to obtain health insurance (an individual mandate) would affect health system performance along nine dimensions.
2009
Assessing Parolees' Health Care Needs and Potential Access to Health Care Services in California — June 17, 2009
California parolees' health care, mental health care, and drug- and alcohol-treatment needs, as well as where parolees go when they return to counties, place significant demands on counties' safety-net resources and on their ability meet those needs.
California Ambulatory Surgery Centers: A Comparative Statistical and Regulatory Description — September 28, 2009
Examines ambulatory surgery centers (ASCs) in California and compares California's regulation of ASCs with that in other states.
Children's Health in Washington, D.C.: Access and Health Challenges Despite High Insurance Coverage Rates — October 28, 2009
Assesses children's health issues in Washington, D.C., including the health care delivery system and neighborhood health environments.
Create or Expand Access to Purchasing Pools — October 12, 2009
This document explores how creating or expanding access to purchasing pools would affect health system performance along nine dimensions.
Health and Health Care Among District of Columbia Youth — September 18, 2009
Assesses health and health care use among youth in Washington, D.C., using a unique combination of survey, administrative, and focus group data, and offers recommendations for addressing District children's health needs.
Open Access to the Federal Employees Health Benefits Program (FEHBP) — October 12, 2009
This document explores how expanding access to the Federal Employees Health Benefits Program (FEHBP) would affect health system performance along nine performance dimensions.
A Policy-Relevant Picture of California's Ambulatory Surgery Centers — October 1, 2009
Examines how California's ambulatory surgical centers (ASCs) compare with hospital outpatient surgery departments and how the state compares with other states in regulating ASCs.
Recent Trends in State Children's Health Insurance Program Eligibility and Coverage for CSHCN — December 1, 2009
This study found that a dramatic increase between 2001 and 2005 in the number of uninsured children with special health care needs who were eligible for SCHIP.
2008
Access to Appointments Based on Insurance Status in Washington, D.C. — August 1, 2008
Using a hypothetical emergency patient requiring close follow-up, D.C. providers were queried by phone to evaluate accessibility. The rate of privately insured receiving appointments was 71%, with Medicaid fee-for-service 36.6% and uninsured 13%.
Falling Short: Continued Challenges in Meeting the Mental Health Needs of Children with Special Health Care Needs — June 1, 2008
High levels of unmet need persist for children with special health care needs in the face of substantial resources that have been committed to improving their care, including the integration of behavioral health into Medicaid managed care.
Immigrants and Health Care: A Complex Picture — January 15, 2008
This fact sheet describes the diverse health care needs of immigrant populations and specifies needs that health policies can target.
The National Health Plan Collaborative to Reduce Disparities and Improve Quality — May 1, 2008
The NHPC represents a model of shared learning and innovation through which health plans are tackling racial/ethnic disparities. Now that most of the plans have some data on their enrollees with diabetes and have begun targeting disparities, they want to capitalize on their collective industry strength to influence policy on issues related to disparities.
Retail Clinics, Primary Care Physicians, and Emergency Departments: A Comparison of Patients' Visits — January 1, 2008
Compares the demographics of and reasons for visits to retail clinics, primary care physicians (PCPs), and emergency departments. Finds that retail clinics appear to be serving a patient population that is underserved by PCPs.
2007
The Effects of Health Sector Market Factors and Vulnerable Group Membership on Access to Alcohol, Drug, and Mental Health Care — June 1, 2007
Uses Andersen's Behavioral Model to see if health sector market conditions affect vulnerable subgroups' use of ADM differently than general population
Estimating the Potential Impact of Regionalizing Health Care Delivery Based on Volume Standards Versus Risk-Adjusted Mortality Rate — January 1, 2007
Whether basing regionalization on risk-adjusted mortality would lead to better population outcomes than basing regionalization on procedure volume.
Immigrants and Health Care: Sources of Vulnerability — September 15, 2007
Immigrants have been identified as a vulnerable population, but there is heterogeneity in the degree to which they are vulnerable to inadequate health care.
Impact of the State Children's Health Insurance Program on Adolescents in New York — January 1, 2007
Adolescents face financial and nonfinancial barriers to health care.
Outcomes in Men Denied Access to a California Public Assistance Program for Prostate Cancer — January 1, 2007
Men denied enrollment into the IMPACT program exhibited worse symptom distress and self-efficacy compared to enrolled men at initial assessment.
Prescription Drug Coverage and Elderly Medicare Spending — January 1, 2007
The introduction of Medicare Part D has generated interest in the cost of providing drug coverage to the elderly.
Social Networks and Access to Health Care Among Mexican-Americans — October 1, 2007
This research explores social networks and their relationship to access to health care among adult Mexican-Americans.
State Insurance Mandates and Consumer-Directed Health Plans: Are They Helping Small Business Provide Health Insurance to Employees? — December 5, 2007
This research brief describes the effects of state health-insurance mandates and consumer-directed health plans (CDHPs) on the access to and affordability of health insurance for small businesses.
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