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.

2020

• 2019 Evaluation of Los Angeles County's WhyWeRise Mental Health Campaign 2020

  Rebecca L. Collins, Nicole K. Eberhart, Rachana Seelam, Rebecca De Guttry, Matthew L. Mizel

  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.

• Association of Pregnancy and Insurance Status With Treatment Access for Opioid Use Disorder 2020

  Stephen W. Patrick, Michael R. Richards, William D. Dupont, Elizabeth McNeer, Melinda Beeuwkes Buntin, Peter R. Martin, Matthew A. Davis, Corey S. Davis, Katherine E. Hartmann, Ashley A. Leech, et al.

  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.

• Engagement of Providers and Advocates in a Rebalancing Initiative to Increase HCBS Access for Medicaid Beneficiaries 2020

  Daniel Siconolfi, Sangeeta C. Ahluwalia, Regina A. Shih, Esther M. Friedman, Debra Saliba

  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.

• Promises and Pitfalls of Health Information Technology for Home and Community-Based Services 2020

  Sangeeta C. Ahluwalia, Esther M. Friedman, Daniel Siconolfi, Debra Saliba, Jessica Phillips, Regina A. Shih

  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.

• When Financial Incentives Backfire: Evidence from a Community Health Worker Experiment in Uganda 2020

  Zachary Wagner, John Bosco Asiimwe, David I. Levine

  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.

2019

• Access, Quality, And Financial Performance Of Rural Hospitals Following Health System Affiliation 2020

  Claire E. O'Hanlon, Ashley M. Kranz, Maria DeYoreo, Ammarah Mahmud, Cheryl L. Damberg, Justin W. Timbie

  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.

• Access to Office-Based Buprenorphine Treatment in Areas With High Rates of Opioid-Related Mortality: An Audit Study 2019

  Tamara Beetham, Brendan Saloner, Sarah E. Wakeman, Marema Gaye, Michael L. Barnett

  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.

• Association Among County-Level Economic Factors, Clinician Supply, Metropolitan or Rural Location, and Neonatal Abstinence Syndrome 2019

  Stephen W. Patrick, Laura J. Faherty, Andrew W. Dick, Theresa A. Scott, Judith Dudley, Bradley D. Stein

  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.

• Detecting and Reducing Post-Traumatic Stress Among Children Exposed to Domestic Violence: A Multi-Agency Early Intervention Program 2019

  Clare Stevens, Lynsay Ayer, Melissa Marie Labriola, Sara-Laure Faraji, Elizabeth Ebright

  This study examined the Child Trauma Response Team and its efforts to reduce PTSD symptoms among children exposed to domestic violence.

• The Ecology of Neonatal Abstinence Syndrome 2019

  Stephen W. Patrick, Laura J. Faherty, Andrew W. Dick, Theresa A. Scott, Judith Dudley, Bradley D. Stein

  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.

• Eight Priorities for Improving Primary Care Access Management in Healthcare Organizations: Results of a Modified Delphi Stakeholder Panel 2020

  Lisa V. Rubenstein, Susanne Hempel, Marjorie S. Danz, Danielle E. Rose, Susan Stockdale, Idamay Curtis, Susan Kirsh

  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.

• Ensuring Access to Timely, High-Quality Health Care for Veterans: Insights from RAND Research 2019

  Carrie M. Farmer, Terri Tanielian

  Testimony submitted to the Senate Committee on Veterans' Affairs on April 10, 2019.

• Evaluation of California's Global Payment Program: Final Report 2019

  Justin W. Timbie, Maria DeYoreo, Jodi L. Liu, Denise D. Quigley, Lesley Baseman, Mary Ellen Slaughter, Alina I. Palimaru, Katherine L. Kahn

  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.

• Evaluation of Technology-Enabled Collaborative Learning and Capacity Building Models: Materials for a Report to Congress 2019

  Shira H. Fischer, Adam J. Rose, Ryan K. McBain, Laura J. Faherty, Jessica L. Sousa, Monique Martineau

  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.

• Examining the Association Between Religiosity and Medical Mistrust Among Churchgoing Latinos in Long Beach, CA 2020

  Daniel F. López-Cevallos, Karen Rocío Flórez, Kathryn Pitkin Derose

  The present study examined the association between religiosity and medical mistrust in a sample of Latino adults attending Catholic and Pentecostal churches in Long Beach, CA.

• Experiences of Medicaid Programs and Health Centers in Implementing Telehealth 2019

  Lori Uscher-Pines, Kathryn E. Bouskill, Jessica L. Sousa, Mimi Shen, Shira H. Fischer

  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.

• Growth and Distribution of Child Psychiatrists in the United States: 2007–2016 2019

  Ryan K. McBain, Aaron Kofner, Bradley D. Stein, Jonathan Cantor, William B. Vogt, Hao Yu

  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.

• Options for Improving Timely Access to Care Reporting in California 2019

  Jeanne S. Ringel, Glenn Melnick, Claude Messan Setodji, Robert Reddick, Susan M. Paddock

  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.

• Rural-Urban Disparities in Access to Home- and Community-Based Services and Supports: Stakeholder Perspectives From 14 States 2019

  Daniel Siconolfi, Regina A. Shih, Esther M. Friedman, Virginia Kotzias, Sangeeta C. Ahluwalia, Jessica Phillips, Debra Saliba

  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.

• Social Marketing of Mental Health Treatment: California's Mental Illness Stigma Reduction Campaign 2019

  Rebecca L. Collins, Eunice C. Wong, Joshua Breslau, M. Audrey Burnam, Matthew Cefalu, Elizabeth Roth

  The California campaign increased service use by leading more individuals to interpret symptoms of distress as indicating a need for treatment.

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