How often does the letter e occur in:
In this study of new Medicaid beneficiaries from Philadelphia, we report 3 key findings. First, only 66.7% of our respondents identified a usual source of primary care, whereas nationally 78% did in 2016.26 Second, only 42.3% identified a usual source of dental care, whereas nationally 64% did during a comparable time period. Third, the supply of nearby providers was not associated with a higher or lower likelihood of identifying a usual source of primary or dental care.
The high percentage of individuals without a usual source of primary or dental care could be due to lack of perceived need, difficulty finding a provider who accepts new Medicaid patients,27 costs not covered by insurance (eg, missed work to attend appointments), or lack of knowledge about the healthcare system.28 Although we hypothesized that individuals living in lower-supply areas would be less likely to find a source of care, Philadelphia is a uniquely high-supply market, potentially affecting our findings and limiting generalizability. For example, the Philadelphia hospital referral region has 87.5 primary care physicians per 100,000 residents compared with the national median of 73.5, and it is near the 90th percentile for physicians overall.29 Second, beneficiaries may seek sources of care that are not necessarily near their home,30 basing their decisions on convenience in relation to shopping centers, workplaces, or public transportation networks. Finally, the point estimates from our model suggest that a relationship between supply and having a usual source of care may exist and is worth exploring in larger data sets across multiple cities.
Although we did not observe a relationship between nearby provider supply and the identification of a usual source of primary or dental care, there are several key issues moving forward. This relationship should be evaluated in other geographic areas (urban and rural) and in those with low provider supply. These evaluations may help determine whether characterizing access in terms of a population to provider ratio—a measure commonly used by policy makers and researchers—is useful.32 Our results ultimately suggest that policy makers and insurance plan managers should better understand what improves access or engagement in healthcare among Medicaid enrollees so that gains in insurance coverage can be translated into gains in health.
The authors thank Carolyn Cannuscio, ScD, for her critical input on survey development and Brittany Harrison, MA, for reviewing earlier versions of this manuscript. They also thank the staff at Benefits Data Trust for survey administration and for identifying individuals in Philadelphia whom they had helped apply for Medicaid.
user
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assistant