Abstract:
To "achieve health equity, eliminate disparities, and improve the health of all population groups" are some of the main goals in Healthy People 2020. It is particularly important to eliminate health disparities among children because investing in pediatric healthcare will have the highest long-term return as it will reduce the burden of the future healthcare costs and it will foster a healthy and productive population. Additionally, while caring for the disadvantaged populations, particularly government-insured children, has been one priority of the public health policies, because of variations in care provisions across states and because of restricted claims' reimbursement rates, these children historically have had lower access to the care system. Understanding the systematic disparities particularly for this population for two major access barriers to healthcare, accessibility (e.g., distance) and availability (e.g., congestion or wait time), and comparing these disparities across multiple states will allow quantification of the impact of state-based health policies. It will also suggest what geographic areas are in need for improving the two dimensions of access.

In this research, we thus focus on measuring the level of accessibility and availability among 14 states in the U.S. and on evaluating disparities between government -insured and private-insured children using optimization modeling. The results of our model give an accurate description of the potential access that children have to primary care since constraints are included in the model to reproduce patients' and providers' behavior in the system. Preliminary results reveal that there is a strong correlation between a community's coverage rate and travel cost, but that there is more variability in congestion.  We also find that the healthcare system in most of states examined is sensitive to reductions in physicians' Medicaid caseload capacity, but resistant to many policies designed to improve access.
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