The allocation of public health resources to address disparities of care

Open Access
Author:
Lee, Hyunji
Graduate Program:
Industrial Engineering
Degree:
Doctor of Philosophy
Document Type:
Dissertation
Date of Defense:
June 18, 2013
Committee Members:
  • Paul Griffin, Dissertation Advisor
  • Harriet Black Nembhard, Committee Member
  • Jose Antonio Ventura, Committee Member
  • Madhu Reddy, Committee Member
Keywords:
  • Health disparity
  • FQHC location
  • Medicaid
  • oral health
  • utilization
  • policy
  • supply
  • demand
  • optimization
Abstract:
Providing comprehensive health care services to all the members in a community is important for the achievement of health equity and for increasing a community members’ quality of life. However, there are many disparities that exist in health care services that affect not only individuals but also the entire community. Two important reasons for disparities in health outcomes are a lack of access to care and a lack of insurance coverage. To address this issue, public awareness and understanding of which groups are most vulnerable, and which interventions are most effective is important. In this thesis, we develop effective interventions to reduce disparities in community health settings. First, we develop an integrated model to examine the impact of both increasing the current government budget for Federally Qualified Health Centers (FQHCs) in Pennsylvania and expanding Medicaid through relaxing the income eligibility limits. We consider the geographic and demographic differences in our model, to consider the tradeoffs between these two policies. The objective of this research is to develop a methodology that will aid in finding a balanced investment between FQHC expansion and relaxing Medicaid eligibility to improve both access (by increasing the number of FQHCs) and coverage (by FQHC and Medicaid expansion). We develop a utility-based framework that we use in a multi-criteria optimization model. The comparison is achieved by integrating these models with publically available data sets that allow for specific estimations of healthcare need. Oral health has been identified as having the greatest disparities for children’s overall health. In the second part of the thesis, we study the consequences of access that lead to these disparities for children’s oral health outcomes. We examine the association between differences in insurance types and oral health outcomes. Specifically, our goal is to determine the factors that would best address the disparity gaps. Differences in oral health outcomes due to insurance comprehensiveness would imply that Medicaid-based policies could be effective at addressing oral health disparities. Finally, we develop an integrated dental supply and demand estimation model for Medicaid children. The model is based on several factors at the county level including income, population density, and number of dentists. The model is tested using county-level data from the Center for Medicaid and Medicare Services (CMS). We use the supply and demand model to assess the two interventions of expanding Medicaid eligibility and increasing Medicaid reimbursement fees in order to increase oral health utilization, which is the key goal of the Oral Health Initiative of the Center for Medicaid and Medicare Services. Furthermore, using a non-linear programming model we develop, we find the optimal balanced investment between those two interventions for each state in the model. The framework developed can be used by policy makers to determine the best way to meet the Oral Health Initiative.