By NextBestFitRacial, income, and geographic disparities
Access and outcomes differ sharply by race, income, and place, partly because Medicaid pays less and providers prefer better-paying patients.
Evidence
- Only about 74% of physicians accept new Medicaid patients vs. 96% for private insurance.
Who's affected
- Black, Hispanic, and Native communities: Access and outcomes differ by race, income, and location.
- Rural residents: Access and outcomes differ by race, income, and location.
- Low- and middle-income households: Access and outcomes differ by race, income, and location.
- Hospitals, clinics, and care organizations: They can select better-paying patients over those with lower-paying coverage.
Under your mix of paths
- Payment differences by insurance type
- Geographic maldistribution
- Structural racism
Related costs
Open questions
- Should every patient's care pay the provider the same?
Caused or worsened by these paths
This problem only matters if one of these paths is chosen.
Funding capital through hospital payments leaves richer systems able to out-invest poorer ones.
Individual exceptions to the standard coverage list raise concerns about equity in coverage decisions.
Giving some facilities staffing waivers leaves patients with unequal protections.
Basing state contributions on historical Medicaid spending locks in historical differences.
Solution paths (2)
Open a path for what it fixes, what it creates or worsens, who gains and who loses, precedents, and how it connects to other paths. See all paths as a decision tree.
Add payments for providers serving deprived areas, based on a deprivation index.
- +Racial, income, and geographic disparities
- −Directs benefits or burdens imperfectly
- −Reduces income or business for affected groups
Universal coverage plus one rate for every patient ends payer-based discrimination (Medicaid patients paying less).
- +Racial, income, and geographic disparities
- −Solves only part of the problem
Also addressed by paths for other problems
Allocating capital by regional need allows investment to be directed to underserved areas.