Racial and Ethnic Disparities in Access to the Medicaid Transportation Benefit and Implications for Patient Outcomes

项目摘要 美国的种族/少数民族人口在获得医疗保健方面面临着普遍的不平等， 利用和结果。交通是一个重要的环境因素，有可能 影响获得护理。过去的研究发现，美国的低收入和少数民族人口 在获得运输方面遇到不成比例的障碍，而改善交通运输具有重大意义， 对卫生保健利用和结果的影响。然而，人们对这一问题的程度知之甚少。 医疗补助非紧急医疗运输（NEMT）福利与种族/民族差异有关， 医疗保健的获得和结果。拟议研究的长期目标是确定如何 交通服务和相关政策与美国的医疗保健差距有关， 用于改善卫生公平性。该项目的总体目标是为州和联邦政府提供证据， 决策者对谁使用NEMT的好处，如何使用和使用的差异与国家级NEMT相关 项目设计，合格性和使用与患者结局的相关性，以及大多数人群的使用障碍 可能有有意义的交通需求来获得护理。核心假设是使用NEMT 受益，以及使用与卫生保健获取和结果之间的关联， 种族/民族和受益人群，作为国家NEMT政策的离散特征的函数， 行政要求。这些假设将通过追求三个具体目标进行测试：（1）检查 种族/民族差异，在州政府一级NEMT利用，并评估之间的相关性 观察到的差异和国家一级的NEMT政策;（2）估计使用和资格之间的关联 对于NEMT的好处和医疗保健的获得和结果，以及这种关联的异质性， 种族/民族;（3）调查NEMT福利管理和使用NEMT的过程，以确定 有效使用NEMT的障碍以及改进该计划的潜在方法。在方法上，该项目将 采用严格的准实验方法，包括差异分析，以及半 与医疗补助受益人、医疗保健提供者和交通提供者进行结构化访谈。的 在申请人看来，拟议的研究是创新的，因为它填补了潜在的关键空白， NEMT有利于减少美国医疗保健的差距，使用定量结果，从一个大的，多， 国家数据源与深入，定性研究的障碍，NEMT使用配对。它还依赖于一个多- 利益相关者咨询委员会，由医疗补助受益人、政策制定者、临床医生和交通部门组成 提供者为研究设计提供信息，并最大限度地转化为政策。该项目意义重大，因为它 将为州和联邦决策者提供关于如何优化NEMT设计的可操作指导 确保在美国公平获得医疗服务。

PROJECT SUMMARY Racial/ethnic minority populations in the United States face pervasive disparities in health care access, utilization, and outcomes. Access to transportation is an important environmental factor that has the potential to affect access to care. Past work has found that low-income and minority populations in the United States encounter disproportionate barriers accessing transportation, and 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 health equity. 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 barriers to use for populations most likely to have meaningful transportation needs 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 barriers to effective NEMT use and 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 on barriers to NEMT use. 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 ensure equitable access to medical care in the United States.