An analysis of pediatric primary health care accessibility and availability in multiple states that uncovered systematic disparities between and within states was presented today at a session of the 2015 Joint Statistical Meetings(JSM 2015) in Seattle.
During an invited presentation titled "Quantifying Disparities in Accessibility and Availability of Pediatric Primary Care with Implications for Policy Making," statistician Nicoleta Serban said the study shows disparities in wait times for pediatric primary care are not as significant as the disparities in travel distance. It also shows both rural and urban communities are in need of improvements in accessibility or travel distance for publicly insured children, although at varying levels across states.
Serban is associate professor in statistics at Georgia Tech. She collaborated on the study with Monica Gentili, visiting assistant professor in optimization, and Julie Swann, professor in operations research, both at Georgia Tech.
While affordability or the ability to pay has been the primary focus of the Patient Protection and Affordable Care Act (ACA), it is not the only impediment to improving health care of the nation's population. "Health care services also need to be accessible within reasonable travel time and available with reasonable wait times," said Serban during her presentation.
In the study, accessibility is defined as how long in distance and/or time it would take a person to reach their chosen health care provider. Availability is defined as the opportunity for patients to choose among different health care services providers.
Serban and her colleagues examined pediatric primary care services in seven states--California, Georgia, Louisiana, Minnesota, Mississippi, North Carolina and Tennessee--that were selected for their different approaches to implementing the Medicaid program and the Children's Health Insurance Program (CHIP), as well as their varying sizes and demographics. Medicaid and CHIP are federal-state partnership programs that help low-income families secure affordable health care coverage for their children.
The study population consisted of more than 9 million children in approximately 16,500 census tracts served by a network of more than 20,000 health care provider locations with about 66,000 individual and group providers.
They analyzed systematic disparities of accessibility and availability at the census tract level and conducted a systematic geographic analysis within and between states across different urban levels and compared care accessibility for publicly insured versus privately insured children.
Among the study's key findings are the following:
The study also identifies where to target interventions within a state, which census tracts as proxies for communities have the highest need for interventions and at what level of improvement. For example:
"We believe policymakers at both the federal and state levels can use this study's findings to enact targeted policies that will address the care accessibility and availability disparities we have identified," said Serban. "The study highlights which geographic areas are in need of improvements to pediatric primary care access for not only publicly insured children, but also privately insured children living in communities with little access to such care."
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