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.
Since 2009, most states have increased the size of their home care workforces and decreased the size of their nursing home workforces, but there is substantial variation across states. More targeted efforts may be needed to ensure that people with disabling conditions can have their needs met in their desired setting across the nation.
New York State's Medicaid Section 1115 Waiver seeks to enroll a majority of Medicaid beneficiaries into managed care, increase access and service quality, and expand coverage to more low-income New Yorkers. This final interim evaluation report examines whether two components of the 1115 Demonstration Waiver—the Managed Long-Term Care (MLTC) program and the 12-month continuous eligibility policy—have helped achieve the program's goals.
Stakeholders reported that BIP participation had a range of impacts on the HCBS ecosystem, often beyond the structural reforms. Our findings highlight BIP impacts to monitor over the long term and to consider in evaluations of future rebalancing efforts.
This cross-sectional study of substance use disorder treatment facilities examined the national share of facilities that offer medication treatment for opioid use disorder (MOUD) and population-based measures of geographic accessibility of facilities offering MOUD.
The use of telehealth services has increased during the COVID-19 pandemic. What role can telehealth play in a post-pandemic health care system? The authors of this Perspective discuss how the ongoing use of telehealth services could affect the realization of policy goals, and offer recommendations for how policymakers might deploy telehealth services to achieve post-pandemic policy goals.
During the COVID-19 pandemic, visit volume at a sample of FQHCs declined modestly for primary care visits and remained stable for behavioral health visits because telehealth visits replaced in-person visits.
The coronavirus disease 2019 pandemic–related recession and resulting job loss raised significant concerns that the U.S. uninsured population could increase, perhaps by millions. However, worrisome predictions about coverage loss have not materialized. RAND researchers (1) assess the importance of temporary provisions in stabilizing health insurance enrollment despite heavy job loss and (2) run simulations using New York state as a case study.
This study aimed to describe strategies CHCs use to integrate care with specialists and examine whether more strongly integrated CHCs have higher rates of screening for colorectal and cervical cancers and report better communication with specialists.
This study found that during the initial phase of the COVID-19 epidemic in March and April of 2020, patients significantly reduced use of preventive and elective care and increased use of telemedicine but not enough to offset reductions in in-person care.
Interviews and a survey indicate that WhyWeRise, a social marketing campaign promoting community engagement with mental health issues, reached at least 30 percent of Los Angeles County youth ages 14–24 and mobilized them to improve societal support for those experiencing mental health challenges. Those exposed to the campaign were more likely than those unexposed to feel empowered to change how their communities deal with mental health issues.
In this cross-sectional study with random assignment of clinicians and simulated-patient callers, many women, especially pregnant women, faced barriers to accessing treatment. Given the high out-of-pocket costs and lack of acceptance of insurance among many clinicians, access to affordable opioid use disorder treatment is a significant concern.
We identified five current cancer coverage state laws and interviewed experts on their perceptions of the relevance of the laws and how well they meet the current needs of cancer care given rapid changes in therapies.
Posttraumatic stress disorder and traumatic brain injury can have significant negative effects on veterans' mental and physical health, yet many veterans have difficulty accessing high-quality care. A rigorously developed, shared definition of high-quality care will help clinical providers and veteran-serving organizations better meet the needs of veterans with these conditions.
Rebalancing long-term services and supports toward increased home- and community-based services will engage and affect multiple stakeholder groups, including governmental and nongovernmental stakeholders. This study describes stakeholder engagement in a LTSS rebalancing initiative.
This exploratory qualitative study describes industry and community stakeholder perceptions of the impacts of cumulative hospital, practice, and insurance mergers, acquisitions, and affiliations in Pittsburgh, Pennsylvania.
In 2016, New York City policymakers came together with federal and private funders to support a program, Connections to Care (C2C), intended to provide quality mental health support within high-risk communities. RAND researchers conducted an evaluation of C2C, examining its implementation across 15 community-based organizations, its impact on access and utilization of mental health care, mental health symptoms, and other outcomes, and its costs.
This article measures the use of and willingness to use telehealth modalities across the U.S. population.
Structural reforms required by the Medicaid Balancing Incentive Program gave states an opportunity to modernize their HCBS systems through health information technology. Barriers to technology adoption persist, underscoring the need for continued support in future rebalancing efforts.
This article assesses racial and ethnic disparities in care for Medicare fee-for-service beneficiaries and whether disparities differ between health system-affiliated physician organizations (POs) and nonaffiliated POs.
A rigorously developed, shared definition of high-quality care for veterans with posttraumatic stress disorder and mild traumatic brain injury will help clinical providers and veteran-serving organizations better meet the needs of this population.
