Strategy overview

  • Promoting and improving access to health care: Increasing access to basic health care services creates the conditions for healthier individuals and families. Strategies to reduce barriers to health care access include federally-qualified health centers, mobile health clinics and tele-health appointments, and financial incentives for preventive care.
  • Bringing health care to the patients: Traveling to a health care facility can be challenging for some individuals and present a barrier to accessing health care. Offering patients the option to access basic health care services virtually or closer to home can increase uptake. Examples of this approach include phone-based applications to deliver mental health services, mobile clinics that provide reproductive health services, and federally-qualified health centers (FQHC).
  • Leveraging federal funding to increase access: Cost is a key barrier to health care access for low- and moderate-income individuals. Federally-qualified health centers are public and nonprofit health care organizations that receive subsidies to provide comprehensive care to an underserved area or population. This approach ensures uninsured or underinsured patients have access to basic health care regardless of ability to pay.
  • Incentivizing preventive care services: Preventive care procedures, like screenings and vaccinations, aim to prevent or reduce the severity of future health problems. One way to increase uptake of preventive care is to offer patients financial incentives, which can offset any out-of-pocket costs for accessing care or reward preventive health behaviors.

Multiple research syntheses of common practices to increase access to health care found significant positive impacts on health care uptake and mental and physical health outcomes.

  • A 2018 research synthesis found strong evidence that financial incentives like vouchers and subsidies were associated with increased use of preventative care for high-risk and low-income individuals.

  • A 2016 research synthesis found strong evidence that federally qualified health centers were associated with a significant increase in health care access and improved health outcomes.

  • A 2018 research synthesis found some evidence that mobile reproductive health clinics increase initiation of prenatal care; further research is needed to confirm effects.

  • A 2018 research synthesis found that text- and app-based mental health services can improve mental health outcomes in the short term; however, further research is needed to confirm long-term effects.

Before making investments in this strategy, city and county leaders should ensure it addresses local needs.

The Urban Institute and Mathematica have developed indicator frameworks to help local leaders assess conditions related to upward mobility, identify barriers, and guide investments to address these challenges. These indicator frameworks can serve as a starting point for self-assessment, not as a comprehensive evaluation, and should be complemented by other forms of local knowledge.

The Urban Institute's Upward Mobility Framework identifies a set of key local conditions that shape communities’ ability to advance upward mobility and racial equity. Local leaders can use the Upward Mobility Framework to better understand the factors that improve upward mobility and prioritize areas of focus. Data reports for cities and counties can be created here.

One indicator in the Upward Mobility Framework may be improved with investments in increasing access to health care. To measure this indicator and determine if investments in these interventions could help, examine the following:

Mathematica's Education-to-Workforce (E-W) Indicator Framework helps local leaders identify the data that matter most in helping students and young adults succeed. Local leaders can use the E-W framework to better understand education and workforce conditions in their communities and to identify strategies that can improve outcomes in these areas.

Several indicators in the E-W Framework may be improved with investments in this strategy. To measure these indicators and determine if investments in this strategy could help, examine the following:

  • Access to health, mental health and social supports: Ratio of number workers or students to number of health, mental health, and social services FTE staff (for example, school nurses, psychologists, and social workers).

  • Mental and emotional well-being: Percentage of youth with mental or emotional health needs as identified by a universal screening tool.

  • Physical development and well-being: Percentage of students meeting benchmarks on self-rated surveys of physical health, such as the California Healthy Kids Survey Physical Health & Nutrition module.

  • Childhood experiences: Percentage of individuals with fewer than three adverse childhood experiences (ACEs).

  • Health insurance coverage: Percentage of individuals with health insurance or percentage of eligible individuals (children or adults) enrolled in Medicaid or CHIP.

  • Focus on community engagement: When individuals trust their health care provider, they are more likely to seek care. Engaging with community members in the design and operation of a program builds familiarity and trust, thereby making uptake and participation more likely.
  • Develop partnerships to provide comprehensive, coordinated care: Programs should build formal relationships with providers in other specialties. By integrating care, providers can help patients navigate the health care environment and address their needs. Examples of this approach include implementing the Patient-Centered Medical Home model and providing patient navigation services.
  • Consider patient experience: Patients can face a number of barriers to accessing care, including those related to cost, insurance coverage, transportation, language barriers, and more. Designing strategies to account for these barriers will increase uptake and improve equity in access to care.
  • Emphasize preventive care: Preventive care, like check-ups and screenings, can help providers and patients identify health problems early, when they are most treatable. Increasing uptake of preventive care in a community can improve overall health and reduce costs associated with managing more serious illness in the future.

Evidence-based examples

Provides health outreach, education, referral and follow-up, case management, advocacy, and home visiting services
Supportive neighborhoods Stable and healthy families

Evidence varies across specific models

Tailored health care to patients’ norms, beliefs, values, language, and literacy skills
Stable and healthy families

Evidence varies across specific models

Delivers comprehensive care to uninsured, underinsured, and vulnerable patients regardless of ability to pay
Stable and healthy families Supportive neighborhoods
Financial incentives such as payments and vouchers used to encourage patients to engage in preventative care, like screenings and vaccinations
Stable and healthy families Supportive neighborhoods
Primary care providers and their teams coordinate care across the health care system, working with patients to address all of their health care needs
Stable and healthy families Supportive neighborhoods
Uses text messaging and mobile device applications to deliver health care services
Supportive neighborhoods
Medically equipped vans staffed by clinicians offering reproductive health services
Supportive neighborhoods