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.

• 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.

• 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.

• 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.

• 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.

• 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.

• Access to High-Cost Medications After a Cap on Monthly Out-of-Pocket Spending in California 2022

  Erin Audrey Taylor, Christine Buttorff, Vishaal Pegany, Lindsay Petersen, Allison Mangiaracino, Emory Wolf, Lance Lang

  This cross-sectional study evaluates the association of a cap on monthly out-of-pocket spending on high-cost drugs with use of these drugs and out-of-pocket spending in California in 2015 and 2016.

• Enhancing Early Engagement (E3) in Mental Health Services Training for Children's Advocacy Center's Victim Advocates: Feasibility Protocol for a Randomized Controlled Trial 2022

  Erin Audrey Taylor, Alex R. Dopp, Kaitlin Lounsbury, Yutian Thompson, Michelle Miller, Ashley Jorgensen, Jane Frances Silovsky

  This feasibility study protocol describes our plans to develop, implement, and evaluate web-based and consultative training for Children's Advocacy Center Victim Advocates to enhance early engagement in evidence-based youth mental health services.

• Evaluation of a Home-Based, Nurse Practitioner–led Advanced Illness Care Program 2022

  Natalie Ernecoff, Stefanie C. Altieri-Dunn, Andrew Bilderback, Cindy L. Wilson, Susan Saxon, Namita Ahuja Yende, Robert Arnold, Michael Boninger

  Evaluation of a nurse-led, home-based serious illness care program (Advanced Illness Care) at UPMC, a health system in Pittsburgh, PA.

2021

• Associations Between Individual Demographic Characteristics And Involuntary Health Care Delays As A Result Of COVID-19 2021

  Matthew R. Rosengart, Jason M. Ward

  We provide the first evidence on associations between individual characteristics and the propensity to experience an involuntary care disruption resulting from the COVID-19 pandemic.

• Characteristics of US Adults Delaying Dental Care Due to the COVID-19 Pandemic 2021

  Ashley M. Kranz, Grace Gahlon, Andrew W. Dick, Bradley D. Stein

  Coronavirus disease 2019 (COVID-19) has disrupted the delivery of health care services, including dental care. The objective of this study was to quantify and describe US adults who delayed dental care due to the COVID-19 pandemic.

• Do Supply-Side Forces Explain Geographic Variation in Health Care Use? 2021

  Matthew R. Rosengart, Robert Kaestner, Jason M. Ward

  We provide new evidence on causal factors behind geographic variation in health care utilization by examining changes in health care use for the near-elderly as they transition from being uninsured into Medicare.

• Early Insights from the Equity-First Vaccination Initiative 2021

  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 COVID-19 vaccination rates in the United States. Five demonstration sites are using hyper-local, community-led strategies to increase vaccine confidence and access.

• Key Findings from RAND Health Care Research on Telehealth Policy 2021

  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, equity, and costs.

• Measures and Methodology for International Comparisons of Health Care System Performance: Final Report 2021

  Laurie T. Martin, Carl Berdahl, Rachel M. Burns, Emily Hoch, Evan D. Peet, Peter S. Hussey

  In 2020, the Immediate Office of the Secretary of the Department of Health and Human Services sought to identify measures that could improve the ability of the United States and other countries to learn from international comparisons of health system performance. RAND Corporation researchers worked with 15 experts in quality measurement, clinical care, and health economics to generate and prioritize potential measure constructs.

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