A New “HOAP” for Inspiring Healthcare Openness, Access, and Reform

Dr. Darcy Bryan of the UCR School of Medicine is a co-author of the new Healthcare Openness and Access Project

The Healthcare Openness and Access Project (HOAP) shows the rankings of all 50 states and the District of Columbia. Courtesy of the Mercatus Center at George Mason University.

RIVERSIDE, Calif. (www.medsch.ucr.edu) — A team of researchers, including Assistant Clinical Professor Darcy Bryan, M.D., of the UC Riverside School of Medicine, has completed work on an ambitious new project that ranks how much flexibility patients and providers have to shape health care across the United States.

Dr. Darcy Bryan, M.D.

Dr. Darcy Bryan, M.D.

Developed at the Mercatus Center at George Mason University, the Healthcare Openness and Access Project (HOAP) project combines raw data series into nearly 40 indicators of openness and access. The indicators are then combined to produce 10 subindexes with which to rank broad areas of state health care policy. The subindexes, in turn, are averaged to produce the HOAP index, which yields an overall ranking of the 50 states and the District of Columbia.

Bryan teamed with Jared Rhoads, a research project manager at the Dartmouth Institute for Health Policy and Clinical Practice, and Robert Graboyes, a senior research fellow with the Mercatus Center on the project, which compares states’ healthcare policies and provides information on how policies vary across the country.

“I became involved with researching and writing the HOAP about a year ago,” said Bryan, who has served patients in inland Southern California for several years. “Our community shares so many of the economic struggles of the rest of the country. Many patients have to wait months to access a primary care physician, or lose their insurance and suffer the consequences of chronic illness.  We must ask ourselves – how we can make the health of our community better?  Are there barriers obstructing our path that can be removed?”

Ultimately, Bryan said the goal of the HOAP is to stimulate discussion among policy makers and spark conversations across state lines.

“For example, California and Oregon allow for the over-the-counter sale of oral contraceptives, but no other state does,” Bryan said. “If you are a state that still mandates a prescription for access to OCPs, you might want to look at California’s experience and see what outcomes have arisen from improved access to contraception.”

Bryan said that one of the most surprising results of the project was that “you could not predict whether a state was more ‘open’ or had less barriers to healthcare access based on major party lines, that is whether it is a ‘red’ or ‘blue’ state. Either party could be responsible for writing legislation prohibiting healthcare reform and innovation.”

For example, California, which is generally considered politically liberal, was ranked near the middle of the 51 jurisdictions analyzed.

“California’s rank of 34 mainly comes from low rankings in the enforcement of the corporate practice of medicine doctrine, which limits healthcare businesses flexibility in corporate structure and function; occupational regulation, mainly through limitations of scope of practice for nurse practitioners; and taxation, multiple provider taxes and taxes on health savings accounts.  California would improve its access and openness to innovation by tackling these regulatory issues,” she said.

Bryan added that the plan is for the HOAP to be updated on an annual basis.

“If the index helps stimulate state healthcare policy change, improving healthcare opportunities for each state’s residents, than the index will have met its goal.  Hopefully there will be competition among the various states to improve their ranking,” she said.

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Additional Contacts

Camille Walsh, Mercatus Center, George Mason University
Tel: (504) 338-8785
E-mail: cwalsh@mercatus.gmu.edu

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