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Spatial dynamics of access to primary care for the medicaid population

Nasim Sabounchi1, Nasser Sharareh2, Fatima Irshaidat3

  • 1Systems Science and Simulation Laboratory (S3L), Department of Systems Science and Industrial Engineering, Binghamton University - State University of New York (SUNY), Binghamton, NY.

Health Systems (Basingstoke, England)
|April 15, 2020
PubMed

Insights

Medicaid expansion and the Affordable Care Act improved primary care access, especially in underserved areas. Geospatial analysis revealed transportation and provider shortages impact care utilization, informing targeted interventions.

Area of Science:

  • Health Services Research
  • Spatial Epidemiology
  • Health Policy Analysis

Background:

  • Primary care (PC) is historically undervalued in the US health system.
  • The Affordable Care Act (ACA) and Medicaid expansion aimed to improve healthcare access.
  • Broome County, NY, with its mix of rural and urban settings, offers a unique case study.

Purpose of the Study:

  • To investigate the impact of Medicaid expansion and ACA provisions on PC access.
  • To identify geospatial factors influencing PC utilization among the Medicaid population.
  • To develop a decision support tool for policymakers to enhance PC access.

Main Methods:

  • Developed a spatial system dynamics model incorporating the Health Belief Model.
  • Utilized government data from NY State Dept. of Health, Medicaid DSRIP, and US Census.
  • Integrated simulation results with Geographical Information System (GIS) maps to analyze spatial influences.

Main Results:

  • Identified demographic "hot spots" with poor PC access due to transportation barriers and provider shortages.
  • The model simulated the effects of hypothetical interventions on PC utilization.
  • Geospatial factors significantly influence PC access for the Medicaid population.

Conclusions:

  • The study provides a novel approach combining spatial modeling and GIS for PC access analysis.
  • Findings highlight the need for targeted interventions addressing transportation and provider distribution.
  • The decision support tool can guide policymakers in optimizing PC service delivery.

Keywords:
GIS mappingMedicaidSpatial system dynamicshealth disparitiesprimary care

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