The Problem of the Color Line: Spatial Access to Hospital Services for Minoritized Racial and Ethnic Groups

Examining how spatial access to health care varies across geography is key to documenting structural inequalities in the United States. In this article and the accompanying StoryMap, our team identified ZIP Code Tabulation Areas (ZCTAs) with the largest share of minoritized racial and ethnic populations and measured distances to the nearest hospital offering emergency services, trauma care, obstetrics, outpatient surgery, intensive care, and cardiac care. In rural areas, ZCTAs with high Black or American Indian/Alaska Native representation were significantly farther from services than ZCTAs with high White representation. The opposite was true for urban ZCTAs, with high White ZCTAs being farther from most services. These patterns likely result from a combination of housing policies that restrict housing opportunities and federal health policies that are based on service provision rather than community need. The findings also illustrate the difficulty of using a single metric—distance—to investigate access to care on a national scale

Psychological Distress and Need for Mental Healthcare: Examining and Modeling Prevalence & Need Using Multiple Datasets

The Patient Protection and Affordable Care Act (ACA) expanded Medicaid eligibility to include non-elderly adults with incomes up to 138 percent of the federal poverty level. As a result, Medicaid enrollment by individuals with severe psychological distress increased (Gonzales et al, 2017). The goal of this dissertation is to use patient-reported outcome measures to examine whether disparities in access to mental healthcare exist in California, a state that expanded health insurance coverage dramatically through the ACA. The literature review in this dissertation discusses the use of patient-reported outcomes, specifically psychological distress, to determine need for mental healthcare. Established theory on behavioral health services utilization is used to examine mental health disparities with specific evidence on race/ethnic group affiliation, health insurance status, and geographic access. California Health Interview Survey data and Medical Expenditure Panel Survey data from 2014-2018, is used to model both the prevalence of and need for mental healthcare among non-elderly adults. Findings suggest the need to examine moderate levels of distress, as this population demonstrates the need for prevention and early intervention. Those most at risk for high levels of distress include non-elderly adults with low socioeconomic status, as socioeconomic status was a better predictor of psychological distress than racial/ ethnic group affiliation. Taken together, the results of this dissertation research suggest that health insurance coverage alone is an insufficient predictor of adequate mental healthcare access