Certain U.S. states have disparities in the accessibility and availability of pediatric primary care, according to a new study presented at the 2015 Joint Statistical Meetings in Seattle.

The study defines accessibility as the amount of time it takes for a patient to reach their chosen health care provider, and availability as the opportunity for patients to choose among different health care service providers.

The ACA puts more of an emphasis on the affordability of health care, but the researchers stressed that it’s not the only hurdle in the way of improving the population’s health. They wrote that health care services need to be within reasonable travel times and have sensible wait times.
The researchers examined the pediatric primary care services in California, Georgia, Louisiana, Minnesota, Mississippi, North Carolina and Tennessee. Those states were selected for their varying sizes and demographics and the different ways they are implementing the Medicaid program and the Children’s Health Insurance Program.

The study included over 9 million children in about 16,500 census areas, served by a network of more than 20,000 health care provider locations with about 66,000 individual and group providers. They found that the disparities in wait times were not as noteworthy as the disparities in travel times.

All of the states except for Minnesota have statistically significant higher median travel time than California for the publicly insured population, and all states were found to have a statistically significant higher median travel time than California for the privately insured population.

They also found that both the rural and urban communities need improvements in accessibility for publicly insured patients.

California has the most potential to better its access for publicly insured children since it has a dense care network and the largest amount of communities with a travel distance of more than two miles compared with the privately insured children. The researchers believe that policy interventions that give providers incentives if they accept public insurance could improve access.

However, providing incentives in states such as Mississippi would not have the same results since access for privately insured children also needs to be improved. In that case, mobile clinics, telehealth and new community-based clinics may reduce disparities.

Accessibility in states such as Georgia and North Carolina is geographically clustered. The researchers recommended implementing locally targeted interventions that combine policy interventions that improve public insurance acceptance, telehealth and mobile clinics.

The researchers hope that federal and state policymakers will use the findings of the study to implement targeted policies that address these disparities.

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