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.

2022

• Availability and Accessibility of Mental Health Services in New York City 2022

  Joshua Breslau, Dionne Barnes-Proby, Mallika Bhandarkar, Jonathan H. Cantor, Russell Hanson, Aaron Kofner, Rosemary Li, Nipher Malika, Alexandra Mendoza-Graf, Harold Alan Pincus

  Mental health services provide essential supports to people living with psychiatric disorders. However, in the United States as a whole and in New York City in particular, the use of mental health services is low and care is not equitably distributed. To advance policy strategy for addressing gaps in the mental health services system, RAND researchers investigate the availability and accessibility of mental health services in New York City.

• Barriers to Chimeric Antigen Receptor T-Cell (CAR-T) Therapies in Clinical Practice 2022

  Ajeet Gajra, Abigail Zalenski, Aishwarya Sannareddy, Yolaine Jeune-Smith, Kandice A. Kapinos, Ankit Kansagra

  The barriers to the use of CAR-T therapy include complex logistics, manufacturing limitations, toxicity concerns, and financial burden. This review discusses solutions to overcome these barriers to make this therapy widely accessible.

• Carve-In Models for Specialty Behavioral Health Services in Medicaid: Lessons for the State of California 2022

  Marcela Horvitz-Lennon, Jonathan S. Levin, Joshua Breslau, Jonah Kushner, Nicole K. Eberhart, Mallika Bhandarkar

  Many states separate, or "carve out," Medicaid financing of behavioral health services from that for other types of health care, but there has been a recent trend in some states toward "carve-ins," whereby financing for behavioral health services is combined with the larger pool of Medicaid-covered services. To inform California's consideration of a carve-in approach, the authors examine the experiences of other states that have implemented it.

• Enhancing Access to and Diversity in Cancer Clinical Trials Through a Financial Reimbursement Program: Protocol to Evaluate a Novel Program 2022

  David E. Gerber, Jasmin A. Tiro, Lorna H. McNeill, Erin L. Williams, Hong Zhu, Simon J. Craddock Lee, Patrick J. Leavey, Navid Sadeghi, Kandice A. Kapinos, Dana L. Dornsife, et al.

  We implemented a financial reimbursement and outreach program designed to increase the number and diversity of participants in cancer clinical trials at centers in Dallas, Houston, and Philadelphia.

• Environmental Scan on Consolidation Trends and Impacts in Health Care Markets 2022

  Jodi L. Liu, Zachary M. Levinson, Annetta Zhou, Xiaoxi Zhao, PhuongGiang Nguyen, Nabeel Qureshi

  To inform the development of No Surprises Act (NSA) reports to Congress, this report summarizes recent patterns of and trends in horizontal and vertical consolidation of hospitals, physician practices, and health insurers; what is known about the impacts of consolidation on health care prices, health care spending, quality of care, patient access, and health care wages; and the potential impact that NSA provisions might have on consolidation.

• Evaluation of Los Angeles County's 2021 WhyWeRise Mental Health Campaign 2022

  Rebecca L. Collins, Nicole K. Eberhart, Elizabeth Roth

  In this report, RAND researchers describe the methods and findings of a survey that they conducted to evaluate the reach and impact of Los Angeles County's 2021 WhyWeRise social marketing campaign, which was focused on raising awareness of the county resources available to support residents' mental health and communicating messages of resilience, support, and hope.

• Expanding Insurance Coverage to Undocumented Immigrants in Connecticut 2022

  Preethi Rao, Federico Girosi, Christine Eibner

  Policymakers in Connecticut are considering various state-funded policy options to improve insurance coverage among undocumented and legally present recent immigrants in the state — almost 60 percent of whom lack health insurance. The authors use the RAND Corporation's COMPARE microsimulation model to estimate the impacts of each policy scenario on premiums, state spending, and hospital spending on uncompensated care.

• Experiences of Health Centers in Implementing Telehealth Visits for Underserved Patients During the COVID-19 Pandemic: Results from the Connected Care Accelerator Initiative 2022

  Lori Uscher-Pines, Natasha Arora, Maggie Jones, Abbie Lee, Jessica L. Sousa, Colleen M. McCullough, Sarita D. Lee, Monique Martineau, Zachary Predmore, Christopher M. Whaley, et al.

  In early 2020, as the COVID-19 pandemic emerged, widespread social-distancing efforts suspended much of the delivery of nonurgent health care. Telehealth proved to be a viable alternative to in-person care, at least on a temporary basis, and utilization skyrocketed. Researchers investigated changes in telehealth utilization and health center staff experiences with implementation.

• Expert Views on State-Level Naloxone Access Laws: A Qualitative Analysis of an Online Modified-Delphi Process 2022

  Sean Grant, Rosanna Smart

  This qualitative study conducted a three-round modified-Delphi process using the online ExpertLens platform. Researchers identified and summarized the views of experts on state-level naloxone access laws.

• The Impact of the COVID-19 Pandemic and Policy Response on Health Care Utilization: Evidence from County-Level Medical Claims and Cellphone Data 2022

  Jonathan H. Cantor, Neeraj Sood, Dena M. Bravata, Megan F. Pera, Christopher M. Whaley

  Shelter-in-place policies during the COVID-19 pandemic were associated with reductions in the use of preventive care, elective care, and the number of weekly visits to physician offices, hospitals and other health care-related industries.

• Imputation of Race and Ethnicity in Health Insurance Marketplace Enrollment Data, 2015–2022 Open Enrollment Periods 2022

  Melony E. Sorbero, Roald Euller, Aaron Kofner, Marc N. Elliott

  Information on the race and ethnicity of individuals enrolled through the Health Insurance Marketplace is critical for assessing past enrollment efforts and determining whether outreach campaigns should be modified. This report presents the results of imputing race and ethnicity for HealthCare.gov Marketplace enrollees from 2015 through 2022 with an approach that uses surnames, first names, and addresses to estimate race and ethnicity.

• Key Findings from RAND Health Care Research on Telehealth Policy 2022

  Lori Uscher-Pines, Shira H. Fischer

  RAND Health Care researchers used public and private data, such as data from health care claims, to understand telehealth's effect on health care delivery and how it affects care quality, access, and equity.

• Ongoing Disparities in Digital and In-Person Access to Child Psychiatric Services in the United States 2022

  Ryan K. McBain, Jonathan H. Cantor, Aaron Kofner, Bradley D. Stein, Hao Yu

  Although telehealth holds promise for promoting access to child and adolescent psychiatric services, large disparities in overall access to services persists in rural and low-income communities.

• Paying for PrEP: A Qualitative Study of Cost Factors That Impact Pre-Exposure Prophylaxis Uptake in the US 2022

  Collette Sosnowy, Zachary Predmore, Lorraine T. Dean, Julia Raifman, Christina Chu, Drew Galipeau, Kristen Nocka, Megan Hoopes, Philip A. Chan

  We conducted semi-structured interviews with 25 men who have sex with men who presented for routine health care at a STD clinic about their experiences with accessing and paying for PrEP.

• Psychiatric and Substance Use Disorder Bed Capacity, Need, and Shortage Estimates in California: Merced, San Joaquin, and Stanislaus Counties 2022

  Jonathan S. Levin, Jonathan H. Cantor, Ryan K. McBain, Nicole K. Eberhart, Christina Crowley, Ingrid Estrada-Darley

  In California, Merced, San Joaquin, and Stanislaus Counties sought to understand the gap between capacity and need for psychiatric and substance use disorder beds. This report estimates bed shortages by triangulating estimates through various data sets, literature review findings, and facility survey responses. The authors use these estimates to inform their recommendations to these counties for improving access to behavioral health care.

• Psychiatric and Substance Use Disorder Bed Capacity, Need, and Shortage Estimates in Sacramento County, California 2022

  Ryan K. McBain, Jonathan H. Cantor, Nicole K. Eberhart, Christina Crowley, Ingrid Estrada-Darley

  Sacramento County, like other counties in the United States, has sought to assess shortages in psychiatric and SUD treatment beds. Using an array of data sets and findings from the literature, as well as a survey of treatment facilities, the authors estimated psychiatric and SUD treatment bed need and capacity in the county—at each level of care—for adults and children/adolescents and identified difficult-to-place populations.

• Trends in Missing Race and Ethnicity Information After Imputation in HealthCare.gov Marketplace Enrollment Data, 2015–2021 2022

  D. Keith Branham, Kenneth Finegold, Lucy Chen, Melony E. Sorbero, Roald Euller, Marc N. Elliott, Benjamin D. Sommers

  More than 30% of HealthCare.gov enrollees do not report race and ethnicity. We used modified Bayesian Improved First Name Surname geocoding imputations to describe enrollment data and assess patterns of missing enrollee race and ethnicity.

• The U.S. Equity-First Vaccination Initiative: Early Insights 2022

  Laura J. Faherty, Jeanne S. Ringel, Malcolm V. Williams, Ashley M. Kranz, Lilian Perez, Lucy B. Schulson, Allyson D. Gittens, Brian Phillips, Lawrence Baker, Priya Gandhi, et al.

  The Equity-First Vaccination Initiative aims to reduce racial/ethnic disparities in U.S. coronavirus vaccination rates. Five demonstration sites are using hyper-local, community-led strategies to increase vaccine confidence and access. This interim report highlights the initial work of selected community-based organizations to which the anchor partners are making subgrants, synthesizes lessons learned so far, and suggests policy implications.

• Wait Times for Veterans Scheduling Health Care Appointments: Challenges with Available Data on the Timeliness and Quality of VA Community Care 2022

  Carrie M. Farmer

  Testimony presented before the U.S. Senate Committee on Veterans' Affairs on September 21, 2022.

• Women Veterans' Access to Reproductive Health Care: Considering VA's New Interim Final Rule 2022

  Kayla M. Williams

  Testimony presented before the U.S. House of Representatives Committee on Veterans' Affairs on September 15, 2022.

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