Association for Public Policy Analysis & Management

Panel: Addressing Barriers to Care: New Avenues for Evidence-Based Health Policy

(Health Policy)

The United States spends more on health care per person than any other country, yet ranks below other high-income countries on life expectancy and a number of other health measures. In addition, there are disparities in health outcomes across communities, socioeconomic groups, and racial and ethnic groups in the United States. Gaps in detection and management of chronic conditions are important contributors to both of these problems. Many individuals who suffer from conditions that comprise top sources of preventable disability and premature death in the United States, such as cancer, hypertension, diabetes and hyperlipidemia, are unaware or do not receive care for other reasons. Increasing detection and treatment of chronic diseases by addressing barriers to care could improve health outcomes in the United States and reduce health disparities. As such, these topics are essential to evidence-based policies to improve health in the United States. In this panel, we investigate several barriers to health care use: cost, awareness, and communication-related concerns. We provide empirical evidence as to how public policies can increase usage of relevant treatment, thereby improving health. Myerson and co-authors find that targeted screenings for chronic conditions can increase physician evaluation and management of previously undiagnosed conditions, reducing the gap in care by about one half. Wherry and co-authors find that increased eligibility for Medicaid during childhood is associated with large reductions in hospitalization and emergency department use related to chronic conditions among African Americans in adulthood, perhaps reflecting prevention of complications related to chronic illness. Sabik and co-authors examine whether Medicaid payment policies are related to usage of cancer screenings, and Dillender demonstrates the causal effect of language barriers on access to health insurance. These findings support a theory that public policy can improve health by reducing cost, awareness, and communication related barriers to health care access, and suggest new avenues for evidence-based policy.