Quantifying Disparities in Accessibility and Availability of Pediatric Primary Care across Multiple States with Implications for Targeted Interventions
通过建模分析七个州的数据，比较公共保险与私人保险儿童、城乡社区在儿科初级医疗可及性和可用性上的差异，发现可及性差异比可用性更显著，且各州改善机会不同。
OBJECTIVE: To quantify disparities in accessibility and availability of pediatric primary care by modeling interventions across multiple states that compare publicly insured versus privately insured children, and urban versus rural communities. DATA SOURCES: Secondary data sources include 2013 National Plan and Provider Enumeration System, 2009 MAX Medicaid claims, 2012 American Community Survey. STUDY DESIGN: The study models accessibility and availability of care for all children in seven states. METHODS: Optimization modeling with access constraints is used to estimate access. Statistical hypothesis testing is used to quantify systematic disparities. PRINCIPAL FINDINGS: California has the best accessibility for privately insured children and Minnesota for publicly insured children. Mississippi has the lowest availability for both populations. Overall, the disparities in availability for pediatric primary care are not as significant as in accessibility. Both rural and urban communities are in need of improvement in accessibility to primary care for publicly insured children, although at varying levels across states. CONCLUSIONS: Disparities in availability are not as significant as disparities in accessibility. Opportunities to improve access to pediatric primary care vary by state. Generating specific recommendations for small areas is critical to enabling health policy decision makers to improvement access.