{"id":"https://openalex.org/W7130934133","doi":"https://doi.org/10.3390/systems14020224","title":"Access to Care in a Capacity-Constrained System: Do Coverage Expansions Improve Health Outcomes? Evidence from U.S. States, 2006\u20132023","display_name":"Access to Care in a Capacity-Constrained System: Do Coverage Expansions Improve Health Outcomes? Evidence from U.S. States, 2006\u20132023","publication_year":2026,"publication_date":"2026-02-22","ids":{"openalex":"https://openalex.org/W7130934133","doi":"https://doi.org/10.3390/systems14020224"},"language":"en","primary_location":{"id":"doi:10.3390/systems14020224","is_oa":true,"landing_page_url":"https://doi.org/10.3390/systems14020224","pdf_url":"https://www.mdpi.com/2079-8954/14/2/224/pdf?version=1772002533","source":{"id":"https://openalex.org/S4210219410","display_name":"Systems","issn_l":"2079-8954","issn":["2079-8954"],"is_oa":true,"is_in_doaj":true,"is_core":true,"host_organization":"https://openalex.org/P4310310987","host_organization_name":"Multidisciplinary Digital Publishing Institute","host_organization_lineage":["https://openalex.org/P4310310987"],"host_organization_lineage_names":["Multidisciplinary Digital Publishing Institute"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Systems","raw_type":"journal-article"},"type":"article","indexed_in":["crossref","doaj"],"open_access":{"is_oa":true,"oa_status":"gold","oa_url":"https://www.mdpi.com/2079-8954/14/2/224/pdf?version=1772002533","any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5038953389","display_name":"Bedassa Tadesse","orcid":"https://orcid.org/0000-0001-9108-9589"},"institutions":[{"id":"https://openalex.org/I4210115145","display_name":"University of Minnesota, Duluth","ror":"https://ror.org/01hy4qx27","country_code":"US","type":"education","lineage":["https://openalex.org/I4210115145"]}],"countries":["US"],"is_corresponding":true,"raw_author_name":"Bedassa Tadesse","raw_affiliation_strings":["Department of Economics and Health Care Management, University of Minnesota\u2014Duluth, 1318 Kirby Drive, Duluth, MN 55812, USA"],"raw_orcid":"https://orcid.org/0000-0001-9108-9589","affiliations":[{"raw_affiliation_string":"Department of Economics and Health Care Management, University of Minnesota\u2014Duluth, 1318 Kirby Drive, Duluth, MN 55812, USA","institution_ids":["https://openalex.org/I4210115145"]}]},{"author_position":"last","author":{"id":"https://openalex.org/A5126573841","display_name":"Iftu Dorose","orcid":null},"institutions":[{"id":"https://openalex.org/I1331243681","display_name":"Children\u2019s Minnesota - St. Paul Hospital","ror":"https://ror.org/00cxkrp74","country_code":"US","type":"healthcare","lineage":["https://openalex.org/I1331243681"]}],"countries":["US"],"is_corresponding":false,"raw_author_name":"Iftu Dorose","raw_affiliation_strings":["People\u2019s Center Clinics & Services, 425 20th Avenue South, Minneapolis, MN 55454, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"People\u2019s Center Clinics & Services, 425 20th Avenue South, Minneapolis, MN 55454, USA","institution_ids":["https://openalex.org/I1331243681"]}]}],"institutions":[],"countries_distinct_count":1,"institutions_distinct_count":2,"corresponding_author_ids":["https://openalex.org/A5038953389"],"corresponding_institution_ids":["https://openalex.org/I4210115145"],"apc_list":{"value":1600,"currency":"CHF","value_usd":1732},"apc_paid":{"value":1600,"currency":"CHF","value_usd":1732},"fwci":0.0,"has_fulltext":true,"cited_by_count":0,"citation_normalized_percentile":{"value":0.27320036,"is_in_top_1_percent":false,"is_in_top_10_percent":false},"cited_by_percentile_year":null,"biblio":{"volume":"14","issue":"2","first_page":"224","last_page":"224"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10391","display_name":"Healthcare Policy and Management","score":0.8352000117301941,"subfield":{"id":"https://openalex.org/subfields/2002","display_name":"Economics and Econometrics"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},"topics":[{"id":"https://openalex.org/T10391","display_name":"Healthcare Policy and Management","score":0.8352000117301941,"subfield":{"id":"https://openalex.org/subfields/2002","display_name":"Economics and Econometrics"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T11531","display_name":"Healthcare Systems and Reforms","score":0.03739999979734421,"subfield":{"id":"https://openalex.org/subfields/2003","display_name":"Finance"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T12781","display_name":"Global Health Care Issues","score":0.037300001829862595,"subfield":{"id":"https://openalex.org/subfields/3600","display_name":"General Health Professions"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/workforce","display_name":"Workforce","score":0.6261000037193298},{"id":"https://openalex.org/keywords/health-care","display_name":"Health care","score":0.5665000081062317},{"id":"https://openalex.org/keywords/medicaid","display_name":"Medicaid","score":0.49300000071525574},{"id":"https://openalex.org/keywords/instrumental-variable","display_name":"Instrumental variable","score":0.4921000003814697},{"id":"https://openalex.org/keywords/poverty","display_name":"Poverty","score":0.4562000036239624},{"id":"https://openalex.org/keywords/panel-data","display_name":"Panel data","score":0.44119998812675476},{"id":"https://openalex.org/keywords/population","display_name":"Population","score":0.41839998960494995},{"id":"https://openalex.org/keywords/health-insurance","display_name":"Health insurance","score":0.3801000118255615},{"id":"https://openalex.org/keywords/variable","display_name":"Variable (mathematics)","score":0.3328000009059906}],"concepts":[{"id":"https://openalex.org/C2778139618","wikidata":"https://www.wikidata.org/wiki/Q13440398","display_name":"Workforce","level":2,"score":0.6261000037193298},{"id":"https://openalex.org/C160735492","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health care","level":2,"score":0.5665000081062317},{"id":"https://openalex.org/C144133560","wikidata":"https://www.wikidata.org/wiki/Q4830453","display_name":"Business","level":0,"score":0.4934000074863434},{"id":"https://openalex.org/C2776534028","wikidata":"https://www.wikidata.org/wiki/Q1141363","display_name":"Medicaid","level":3,"score":0.49300000071525574},{"id":"https://openalex.org/C162144332","wikidata":"https://www.wikidata.org/wiki/Q1665305","display_name":"Instrumental variable","level":2,"score":0.4921000003814697},{"id":"https://openalex.org/C189326681","wikidata":"https://www.wikidata.org/wiki/Q10294","display_name":"Poverty","level":2,"score":0.4562000036239624},{"id":"https://openalex.org/C6422946","wikidata":"https://www.wikidata.org/wiki/Q857354","display_name":"Panel data","level":2,"score":0.44119998812675476},{"id":"https://openalex.org/C162118730","wikidata":"https://www.wikidata.org/wiki/Q1128453","display_name":"Actuarial science","level":1,"score":0.4325999915599823},{"id":"https://openalex.org/C100001284","wikidata":"https://www.wikidata.org/wiki/Q2248246","display_name":"Public economics","level":1,"score":0.421999990940094},{"id":"https://openalex.org/C2908647359","wikidata":"https://www.wikidata.org/wiki/Q2625603","display_name":"Population","level":2,"score":0.41839998960494995},{"id":"https://openalex.org/C2983635472","wikidata":"https://www.wikidata.org/wiki/Q334911","display_name":"Health insurance","level":3,"score":0.3801000118255615},{"id":"https://openalex.org/C4249254","wikidata":"https://www.wikidata.org/wiki/Q3044431","display_name":"Demographic economics","level":1,"score":0.361299991607666},{"id":"https://openalex.org/C162324750","wikidata":"https://www.wikidata.org/wiki/Q8134","display_name":"Economics","level":0,"score":0.3411000072956085},{"id":"https://openalex.org/C182365436","wikidata":"https://www.wikidata.org/wiki/Q50701","display_name":"Variable (mathematics)","level":2,"score":0.3328000009059906},{"id":"https://openalex.org/C47344431","wikidata":"https://www.wikidata.org/wiki/Q1519812","display_name":"Health policy","level":3,"score":0.31520000100135803},{"id":"https://openalex.org/C47487241","wikidata":"https://www.wikidata.org/wiki/Q5227230","display_name":"Data access","level":2,"score":0.3089999854564667},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.2831999957561493},{"id":"https://openalex.org/C12713177","wikidata":"https://www.wikidata.org/wiki/Q1900281","display_name":"Perspective (graphical)","level":2,"score":0.28110000491142273},{"id":"https://openalex.org/C3018457447","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Healthcare delivery","level":3,"score":0.27320000529289246},{"id":"https://openalex.org/C2778149918","wikidata":"https://www.wikidata.org/wiki/Q3291156","display_name":"Population health","level":3,"score":0.26829999685287476},{"id":"https://openalex.org/C2776269092","wikidata":"https://www.wikidata.org/wiki/Q1611074","display_name":"Residence","level":2,"score":0.2671000063419342},{"id":"https://openalex.org/C85079727","wikidata":"https://www.wikidata.org/wiki/Q3560114","display_name":"Quarter (Canadian coin)","level":2,"score":0.26429998874664307},{"id":"https://openalex.org/C145236788","wikidata":"https://www.wikidata.org/wiki/Q28161","display_name":"Labour economics","level":1,"score":0.26350000500679016},{"id":"https://openalex.org/C2780877353","wikidata":"https://www.wikidata.org/wiki/Q2518253","display_name":"Health services research","level":3,"score":0.257999986410141},{"id":"https://openalex.org/C27574286","wikidata":"https://www.wikidata.org/wiki/Q320723","display_name":"Variables","level":2,"score":0.2556999921798706},{"id":"https://openalex.org/C2988170871","wikidata":"https://www.wikidata.org/wiki/Q11000047","display_name":"Healthcare system","level":3,"score":0.2533999979496002},{"id":"https://openalex.org/C2775994111","wikidata":"https://www.wikidata.org/wiki/Q843478","display_name":"Rationing","level":3,"score":0.2524000108242035},{"id":"https://openalex.org/C2777402240","wikidata":"https://www.wikidata.org/wiki/Q6783436","display_name":"Masking (illustration)","level":2,"score":0.25209999084472656},{"id":"https://openalex.org/C2776643233","wikidata":"https://www.wikidata.org/wiki/Q1414593","display_name":"Patient Protection and Affordable Care Act","level":4,"score":0.250900000333786}],"mesh":[],"locations_count":2,"locations":[{"id":"doi:10.3390/systems14020224","is_oa":true,"landing_page_url":"https://doi.org/10.3390/systems14020224","pdf_url":"https://www.mdpi.com/2079-8954/14/2/224/pdf?version=1772002533","source":{"id":"https://openalex.org/S4210219410","display_name":"Systems","issn_l":"2079-8954","issn":["2079-8954"],"is_oa":true,"is_in_doaj":true,"is_core":true,"host_organization":"https://openalex.org/P4310310987","host_organization_name":"Multidisciplinary Digital Publishing Institute","host_organization_lineage":["https://openalex.org/P4310310987"],"host_organization_lineage_names":["Multidisciplinary Digital Publishing Institute"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Systems","raw_type":"journal-article"},{"id":"pmh:oai:doaj.org/article:55d2431ce35d4656b44826a92fde5f7f","is_oa":false,"landing_page_url":"https://doaj.org/article/55d2431ce35d4656b44826a92fde5f7f","pdf_url":null,"source":{"id":"https://openalex.org/S4306401280","display_name":"DOAJ (DOAJ: Directory of Open Access Journals)","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"host_organization":null,"host_organization_name":null,"host_organization_lineage":[],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"submittedVersion","is_accepted":false,"is_published":false,"raw_source_name":"Systems, Vol 14, Iss 2, p 224 (2026)","raw_type":"article"}],"best_oa_location":{"id":"doi:10.3390/systems14020224","is_oa":true,"landing_page_url":"https://doi.org/10.3390/systems14020224","pdf_url":"https://www.mdpi.com/2079-8954/14/2/224/pdf?version=1772002533","source":{"id":"https://openalex.org/S4210219410","display_name":"Systems","issn_l":"2079-8954","issn":["2079-8954"],"is_oa":true,"is_in_doaj":true,"is_core":true,"host_organization":"https://openalex.org/P4310310987","host_organization_name":"Multidisciplinary Digital Publishing Institute","host_organization_lineage":["https://openalex.org/P4310310987"],"host_organization_lineage_names":["Multidisciplinary Digital Publishing Institute"],"type":"journal"},"license":"cc-by","license_id":"https://openalex.org/licenses/cc-by","version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Systems","raw_type":"journal-article"},"sustainable_development_goals":[{"display_name":"No poverty","score":0.7647750377655029,"id":"https://metadata.un.org/sdg/1"}],"awards":[],"funders":[],"has_content":{"grobid_xml":true,"pdf":true},"content_urls":{"pdf":"https://content.openalex.org/works/W7130934133.pdf","grobid_xml":"https://content.openalex.org/works/W7130934133.grobid-xml"},"referenced_works_count":0,"referenced_works":[],"related_works":[],"abstract_inverted_index":{"Coverage":[0],"expansions":[1,193],"and":[2,27,58,85,108,111,148,158,211],"affordability":[3],"reforms":[4,205],"often":[5],"presume":[6],"that":[7,75,123],"improved":[8],"access":[9,32,56,65,128,192,204],"to":[10,44,54,89,191],"care":[11,99],"yields":[12],"better":[13],"population":[14],"health.":[15],"We":[16],"examine":[17],"this":[18],"premise":[19],"in":[20,126,155,170,186,208],"a":[21,95,183],"capacity-constrained":[22],"healthcare":[23,50,209],"system,":[24],"where":[25],"congestion":[26],"throughput":[28],"determine":[29],"whether":[30,60],"potential":[31],"translates":[33],"into":[34],"realized":[35],"care.":[36],"Using":[37],"U.S.":[38],"state-year":[39],"panel":[40],"data":[41],"from":[42],"2006":[43],"2023,":[45],"we":[46],"study":[47],"(i)":[48],"how":[49],"workforce":[51,77,161],"density":[52,78,162],"relates":[53],"multiple":[55],"margins":[57],"(ii)":[59],"the":[61,116,135,180,188,200],"mortality":[62],"effects":[63,175],"of":[64,98,115,202],"improvements":[66,125],"depend":[67,194],"on":[68,195],"local":[69,196],"delivery":[70,197],"capacity.":[71],"Reduced-form":[72],"estimates":[73,142],"show":[74],"higher":[76,82],"is":[79],"associated":[80,130],"with":[81,93,131,206],"insurance":[83],"coverage":[84],"fewer":[86],"cost-related":[87],"barriers":[88],"care,":[90],"while":[91,173],"associations":[92],"having":[94],"usual":[96],"source":[97],"are":[100,129,153,168,176],"weaker.":[101],"With":[102],"full":[103],"controls":[104],"these":[105],"relationships":[106],"attenuate,":[107],"Medicaid":[109],"expansion":[110],"poverty":[112],"explain":[113],"much":[114],"remaining":[117],"variation.":[118],"Instrumental":[119],"variable":[120],"models":[121],"suggest":[122],"policy-driven":[124],"effective":[127],"lower":[132],"mortality,":[133,150,166],"although":[134],"first-stage":[136],"strength":[137],"varies":[138],"across":[139],"specifications.":[140],"Interaction-IV":[141],"indicate":[143],"capacity":[144],"dependence:":[145],"for":[146,164],"all-cause":[147],"external-cause":[149],"implied":[151],"benefits":[152,167],"larger":[154],"lower-capacity":[156],"settings":[157],"diminish":[159],"as":[160],"increases;":[163],"endocrine":[165],"concentrated":[169],"higher-capacity":[171],"settings,":[172],"respiratory":[174],"not":[177],"detectable.":[178],"Overall,":[179],"results":[181],"support":[182],"systems":[184],"perspective":[185],"which":[187],"health":[189],"returns":[190],"capacity,":[198],"underscoring":[199],"importance":[201],"aligning":[203],"constraints":[207],"production":[210],"flow.":[212]},"counts_by_year":[],"updated_date":"2026-05-21T06:26:12.895304","created_date":"2026-02-23T00:00:00"}
