No abstract

Although community health centers (CHCs) provide primary health services to the medically underserved and poor, limited access to off-site specialty services may lead to poorer outcomes among underinsured CHC patients. This study evaluates access to specialty health services for patients receiving care in CHCs, using a survey of medical directors of all federally qualified CHCs in the United States in 2004. Respondents reported that uninsured patients had greater difficulty obtaining access to off-site specialty services, including referrals and diagnostic testing, than did patients with Medicaid, Medicare, or private insurance.

The Health Disparities Collaboratives significantly improved the processes of care for two of the three conditions studied. There was no improvement in the clinical outcomes studied.

Background Physicians naturally form networks. Networks could form a rational basis for Accountable Care Organizations (ACOs) for defined populations of Medicare beneficiaries. Objectives To use methods from network science to identify naturally occurring networks of physicians that might be best suited to becoming ACOs. Research Design, Subjects, and Measures Using nationally representative claims data from the Medicare program for CY 2006 on 51 hospital referral regions (HRRs), we used a network-science based community-detection algorithm to identify groups of physicians likely to have pre-established relationships. We examined the proportion of care delivered within communities and compared our results to potential ACOs organized around single hospitals. Results We studied 4,586,044 Medicare beneficiaries from 51 HRRs who were seen by 68,288 active physicians practicing in those HRRs. The median community-based network ACO had 150 physicians with 5,928 ties whereas the median hospital-based network ACO had 96 physicians with 3,276 ties. Seventy-seven percent of physician visits occurred with physicians in the community-based networks as compared with 56% with physicians in the hospital-based networks; however, just 8% of specialist visits were to specialists within the hospital-based networks as compared with 60% of specialist visits within the community-based networks. Some markets seemed better suited to developing ACOs based on network communities than others. Conclusions We present a novel approach to identifying groups of physicians that might readily function as ACOs. Organic networks identified and defined in this natural and systematic manner already have physicians who exhibit close working relationships, and who, importantly, keep the vast majority of care within the networks.

White Americans tend to believe that there has been greater progress toward racial equality than do Black Americans. The authors explain this difference by combining insights from prospect theory and social dominance theory. According to prospect theory, changes seem greater when framed as losses rather than gains. Social dominance theory predicts that White Americans tend to view increases in equality as losses, whereas Black Americans view them as gains. In Studies 1 and 2, the authors experimentally tested whether groups judge the same change differently depending on whether it represents a loss or gain. In Studies 3-6, the authors used experimental methods to test whether White participants who frame equality-promoting changes as losses perceive greater progress toward racial equality. The authors discuss theoretical and political implications for progress toward a just society.