Mapping the Delivery System Serving Low-Income Populations


Many of the Affordable Care Act’s coverage expansions target people with low income. The law’s effectiveness in helping this population, however, will ultimately be determined in large part by the adequacy of the health care delivery system that serves the poor. There is only limited information available at the regional level about providers that treat low-income patients, and no comprehensive understanding at the national level. Increasing our knowledge of the composition and organization of this component of the delivery system will be critical to understanding the impact of the ACA for low-income people. This study will characterize the evolution of health systems serving low-income populations since the ACA’s enactment in 2010. Project staff will construct a comprehensive national database integrating up to 19 data sets that contain provider and hospital data; Medicare, Medicaid and commercial claims data; and demographic information. The new database will help answer key questions related to the adequacy of delivery systems serving low-income populations from region to region. First, the project will analyze the availability of providers for low-income patients within “primary care service areas”—local geographic zones where individuals typically seek out primary care—and compare provider supply and organization in low- and high-income areas, as well as in Medicaid expansion states and nonexpansion states. For the second part of the study, project staff will analyze delivery system changes over time for low-income populations since the ACA’s passage. Intended for an audience of national policymakers, local delivery system leaders, and state Medicaid directors, the project’s findings could potentially inform the development of policies to ensure adequate access to high-quality, efficient care for vulnerable populations.

Grant Details

Grantee Organization:
President and Fellows of Harvard College
Principal Investigator:
Michael Chernew, Ph.D.
Award Amount:
Approval Date:
July 13, 2016

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