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.
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.
Despite stronger financial incentives for community health workers, the entrepreneurial model led to substantially less effort (fewer household visits) than the free delivery model. Our results call into question the notion that an entrepreneurial model necessarily increases community health worker effort relative to free distribution.
Health system affiliation was associated with improved financial performance for rural hospitals but that it also could reduce local access to certain services and was not associated with improved health care quality for the two measures examined.
In the six jurisdictions with the highest rate of opioid-related mortality in 2016, the most prominent barrier to accessing buprenorphine treatment was the difficulty of finding clinicians.
This analysis found a significant association among higher long-term unemployment, higher mental health clinician shortage areas, and higher county-level rates of neonatal abstinence syndrome.
This study examined the Child Trauma Response Team and its efforts to reduce PTSD symptoms among children exposed to domestic violence.
Newborns exposed to opioids before birth can experience withdrawal symptoms known as neonatal abstinence syndrome (NAS). From 2009 to 2015, the average NAS rate per 1,000 hospital births across eight states rose from about six to more than 25.
The panel achieved consensus on definitions of optimal access and access management, on eight urgent and important priorities for guiding access management improvement, and on 1–3 recommendations per priority. Each recommendation is supported by referenced, panel-approved suggestions for implementation.
Testimony submitted to the Senate Committee on Veterans' Affairs on April 10, 2019.
The Global Payment Program (GPP) seeks to improve health care for California's uninsured by using federal funds to make prospective payments to public health care systems for providing inpatient, outpatient, and nontraditional services. This report presents the final evaluation of the program. Through the GPP, public health care systems have put in place a variety of strategies and offered a wider range of services during its first three years.
Technology-enabled collaborative learning and capacity-building models connect generalist providers, often located in remote areas, with specialist teams that help train these providers so that they can deliver care for conditions that generalists might not otherwise feel adequately prepared to handle. This report focuses on the quality of evidence for the effectiveness of such models and describes ways to improve measurement of effectiveness.
Despite telehealth's potential to improve access to care, it is underutilized by safety-net providers, including Federally Qualified Health Centers (FQHCs), due to a range of policy, organizational, and logistical barriers. This research facilitates state-to-state learning to inform both Medicaid policy and Medicare policy going forward and provide lessons learned for FQHCs interested in starting or expanding telehealth programs.
Despite the increased ratio of child psychiatrists per children over the past decade, a shortage remains, particularly in places with lower levels of income and education.
The state of California has taken the lead in developing metrics, standards, and a methodology for collecting the needed data for monitoring timely access to health care, but health plans have faced numerous challenges in collecting and reporting this information. This report focuses on specific concerns with the methodology; the authors use a multipronged approach to describe and document these issues and identify and assess potential solutions.
This paper presents findings from a qualitative study examining the impact of the Medicaid Balancing Incentive Program. The analysis in this paper examines factors associated with rural disparities in access to home and community-based services.
The California campaign increased service use by leading more individuals to interpret symptoms of distress as indicating a need for treatment.
In a survey of community health center medical directors in 9 Medicaid expansion states and DC, nearly 60% reported difficulty obtaining new specialist visits and multiple access barriers on behalf of their patients.
The 33 studies reviewed identify multiple workforce-related challenges for families seeking treatment for children with autism spectrum disorder-including lack of primary care providers to serve these children, lack of specialty providers, and sociodemographic and geographic disparities in access to ASD services.
Beneficiaries who are dually enrolled in Medicare and Medicaid are less likely to be enrolled in Medicare Advantage (MA) plans that perform well in the MA Star Rating program than non–dually enrolled beneficiaries. The authors identify the types of services that MA plans implement to meet the needs of dually enrolled and other high-cost, high-need beneficiaries, as well as the types of resources needed to implement these services.
This article presents a comprehensive theory describing how integrating structures, processes, and people within and across organizations might lead to integrated patient care and improved outcomes, including technical quality, efficiency, patient health, and both patient and provider experience.
