Research shows access to primary care doctors lacking for some
When the Affordable Care Act passed, Portland State University economists Rajiv Sharma and Arnab Mitra, and Oakland University's Miron Stano saw an opportunity.
The shift in the health care market created something that's exceedingly rare for health economists like Sharma and Stano: a natural experiment. They teamed up with Mitra to create a study that would show how populations are accessing primary care physicians, while examining the effects of federal and state policies.
Sharma's team created the Longitudinal Access to Physicians study, an innovative research model that used simulated patients with distinct insurance, race/ethnicity, and gender profiles. The study's design allowed the team to address deficiencies found in studies based on administrative data, such as billing records, and surveys. Using the patient profiles, student researchers made phone calls to a national random sample of physicians to request information on appointment availability.
The researchers were then able to correlate the availability of appointments for different types of patients. They found that the disparities of access were substantially greater than previously reported using different methodologies.
A white male self-pay patient, the profile found to have the highest access, was able to get an appointment 70 percent of the time. Meanwhile, a Hispanic woman on Medicaid, the profile with the lowest access, was offered an appointment only 14 percent of the time.
With support from the PSU Institute for Sustainable Solutions, the College of Liberal Arts and Sciences, and Research and Strategic Partnerships, the Longitudinal Access to Physicians Study this year earned a two-year, $435,000 National Institutes of Health grant.
Sharma and his team, which recently published their first results in the journal Economics Letters, will continue to collect data with the support of the NIH grant. Currently, the researchers are also gathering data with profiles that examine access for patients who are smokers and those who are obese. In future years, Sharma plans to examine patients in neighborhoods with environmental issues, and those who live in poverty.
"Our plan is to use the momentum we have to make PSU a center for research in disparities and access, and assess the effects of federal and state policies on access to primary care physicians," Sharma said.
