A Systems Approach to Evaluating Medicaid Expansion for Access to Primary Care for Socioeconomically Disadvantaged Women in New York State

The Affordable Care Act (ACA) attempts to increase access to insurance coverage and to expand Medicaid eligibility. When several states opted out of the Medicaid expansion program, millions of disadvantaged low-income Americans were excluded from insurance coverage. In the states that participated in the expansion, socio-economically disadvantaged women gained access to both screenings and routine visits to primary care providers.

Using a system dynamics (SD) approach, the goal of this presentation is to explore how the Medicaid expansion policy impacts female-specific screenings and routine visits to primary care providers among socio-economically disadvantaged women in Upstate New York. Considering that different key factors interact over time and make this a complex problem, an SD approach is ideal for addressing our goal. An SD approach focuses on understanding the relationship between the structure of a complex system and the resulting dynamic behaviors generated through multiple interacting feedback loops.

Specifically, this presentation will report:

• The process of developing the SD model, including the results of key informant interviews with various local stakeholders and experts in the field, and
• The initial results of the simulation model to determine how the Medicaid expansion policy impacts female-specific screenings and routine visits to primary care providers among socio-economically disadvantaged women in Upstate New York.

The long-term goal is to use the SD model to test different hypotheses and evaluate various strategies and their combinations to help evaluate the efficacy of health policies at the state/federal level in improving health and well being of socio-economically disadvantaged women.