Document text
Principal Investigator: Jamila D Michener
Organization: CORNELL UNIVERSITY
Fiscal Year: 2024
Award: $561,520
Funding agency: National Institute on Minority Health and Health Disparities
ABSTRACT
Racial/ethnic minority populations in the United States face pervasive disparities in health care access, utilization, and outcomes. Access to transportation is an important factor that has the potential to affect access to care. Past work has found that improved transportation has significant impacts on both health care utilization and outcomes. Little is known, however, about the extent to which the Medicaid non-emergency medical transportation (NEMT) benefit is associated with racial/ethnic disparities in health care access and outcomes. The long-term goal of the proposed research is to determine how transportation services and related policy are related to health care disparities in the United States and can be used to improve access to care. The overall objective of this project is to provide evidence for state and federal policymakers on who uses the NEMT benefit, how use and disparities in use correlate with state-level NEMT program design, how eligibility and use correlate with patient outcomes, and how to ensure meaningful transportation to access care. The central hypothesis is that use of the NEMT benefit, and the association between use and health care access and outcomes, vary substantially by race/ethnicity and across beneficiary populations, as a function of discrete features of states’ NEMT policies and administrative requirements. These hypotheses will be tested by pursuing three specific aims: (1) examine racial/ethnic disparities in beneficiary-level NEMT utilization across states and assess the correlation between observed disparities and state-level NEMT policies; (2) estimate the association between use of and eligibility for the NEMT benefit and health care access and outcomes, as well as heterogeneity in this association by race/ethnicity; and (3) investigate the process of NEMT benefit administration and use of NEMT to identify potential ways to improve the program. Methodologically, the project will employ rigorous quasi-experimental approaches, including difference-in-differences analyses, as well as semi-structured interviews with Medicaid beneficiaries, health care providers, and transportation providers. The proposed research is innovative, in the applicants’ opinion, because it fills critical gaps on the potential for the NEMT benefit to reduce health care disparities in the United States using quantitative findings from a large, multi-state data source paired with in-depth, qualitative research. It also relies on a multi-stakeholder advisory board composed of Medicaid beneficiaries, policymakers, clinicians, and transportation providers to inform the research design and maximize translation to policy. The project is significant because it will provide actionable guidance for state and federal policymakers on how to optimize the design of the NEMT benefit to improve access to medical care in the United States.
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disparities><Measures><Medicaid><Medicaid eligibility><Medical><Medicare/Medicaid><Methodology><Minority Groups><Minority People><Minority Population><Minority individual><Mission><Mitigate health disparities><NCMHD><NIMHD><National Center on Minority Health and Health Disparities><National Institute of Minority Health and Health Disparities><National Institute on Minority Health and Health Disparities><Non-Hispanic><Nonhispanic><Not Hispanic or Latino><Outcome><Patient outcome><Patient-Centered Outcomes><Patient-Focused Outcomes><Patients><People with Disabilities><Persons with Disabilities><Physicians><Policies><Policy Maker><Population><Pregnant Women><Primary Care><Process><Protocol Screening><Provider><Public Health><Qualitative Research><Quasi-experiment><Quasi-experimental analysis><Quasi-experimental approach><Quasi-experimental design><Quasi-experimental methods><Quasi-experimental research><Quasi-experimental study><Quasi-experimental technique><Race><Races><Reduce health disparities><Research><Research Design><Services><Social outcome><Structure><Study Type><Testing><Translations><Transportation><Underserved Population><United States><Variant><Variation><Vulnerable Populations><Work><access disparities><access to health care><access to health services><access to healthcare><access to services><access to transportation><access to treatment><accessibility disparities><accessibility of health care><accessibility to health care><accessibility to health services><accessibility to healthcare><aged><availability of services><beneficiary><burden of disease><burden of illness><care access><care outcomes><copayment><cost><cost effective><design><designing><disabled individual><disabled people><disease burden><disparities in access><disparities in race><disparity due to race><disparity in care><disparity in ethnic><disparity in healthcare><disparity reduction><environmental risk><ethnic based disparity><ethnic disadvantage><ethnic disparities in health><ethnic disparity><ethnic health disparity><ethnic inequality><ethnic inequity><ethnic minority group><ethnic minority individual><ethnic minority people><ethnic minority population><ethnicity disparity><expectant mother><expecting mother><faces><facial><federal policy><health care access><health care availability><health care disparity><health care inequality><health care inequity><health care outcomes><health care personnel><health care service access><health care service availability><health care service use><health care service utilization><health care worker><health equity><health provider><health service access><health services availability><health workforce><healthcare access><healthcare accessibility><healthcare availability><healthcare disparity><healthcare inequality><healthcare inequity><healthcare outcomes><healthcare personnel><healthcare service access><healthcare service availability><healthcare service use><healthcare service utilization><healthcare utilization><improve minority health><improved><improvement of minority health><individuals with disabilities><inequality due to race><inequality in access><inequity due to race><inequity in access><inequity in accessibility><innovate><innovation><innovative><interventional strategy><low SES><low income individual><low income people><low socio-economic position><low socio-economic status><low socioeconomic position><low socioeconomic status><medical appointment><medical personnel><mitigate disparity><novel><patient oriented outcomes><patient population><pregnant mothers><prior authorization><programs><race based disparity><race based inequality><race based inequity><race disparity><race related disparity><race related inequality><race related inequity><racial><racial background><racial disparity><racial inequality><racial inequity><racial minority group><racial minority individual><racial minority people><racial minority population><racial origin><racially unequal><reduce disparity><reduction in disparity><service availability><social health determinants><study design><translation><transportation access><treatment access><treatment provider><under served group><under served individual><under served people><under served population><underserved group><underserved individual><underserved people><vulnerable group><vulnerable individual><vulnerable people>