94 - Racial and Socioeconomic Inequities in Parking Fees for Well-Child Care Visits

Poster Number: 94
Publication Number: 94.211

Deniz Cataltepe, University of Massachusetts Medical School, Weston, MA, United States; Rulan Lyu, UMass Memorial Health, Worcester, MA, United States; Yorghos Tripodis, Boston University School of Public Health, Boston, MA, United States; Tracey A. Wilkie, UMass Memorial Children's Medical Center, worcester, MA, United States; Alon Peltz, Harvard Medical School, Boston, MA, United States; Lawrence Rhein, University of Massachusetts Medical School, Waban, MA, United States; Arvin Garg, University of Massachusetts Medical School, Worcester, MA, United States

Background:
Racial/ethnic and socioeconomic health inequities permeate the U.S. healthcare system and are often perpetuated by structural barriers to accessing care. Well-child care visits (WCV) are vital for promoting children’s physical, emotional, and social development to support optimal health. Studies have shown racial/ethnic and socioeconomic disparities within WCV adherence, but little is known about whether these inequities exist regarding paying for parking, a potential structural barrier to WCV adherence.

Objective:
This study aimed to assess the racial/ethnic and socioeconomic inequities with parking fees among families attending WCV in a large healthcare system, and whether parking fees were associated with differing rates of WCV adherence.

Design/Methods:
We gathered data on WCV rates, patient race/ethnicity, insurance type, and parking fees at 53 hospital- and community-based pediatric and family medicine practices across the UMass Memorial Health system from September 2020 through August 2021. Patient data was extracted from the EPIC electronic health record and was unidentified, anonymous, and aggregated. Parking fee information was collected from practices. WCV rates were calculated using the Healthcare Effectiveness Data and Information Set specifications. Statistical analyses were performed using SAS, and chi-square was used to examine the associations between race/ethnicity and insurance type with parking fees, and between WCV adherence and parking fees.

Results:
The cohort was composed of 34,142 children across 53 practices. Thirteen of these practices required parking fees and were predominantly hospital-based sites. Overall, 70.2% of all Black and Hispanic children attended a practice with parking fees compared to 23.2% of white children (P <0.001). Similarly, 51.8% of children with Medicaid insurance received WCV at a practice with parking fees compared to 28.2% of children with private insurance (P <0.001). Children who received care at practices with parking fees had lower rates of WCV; 74.2% vs 80.5% (P <0.001).
Conclusion(s):
This is the first study to our knowledge examining racial/ethnic and socioeconomic inequities with receiving medical care related to practice parking fees. Black and Hispanic patients as well as patients with Medicaid insurance were disproportionately more likely to seek well-child care at practices with parking fees, and parking fees were associated with lower WCV adherence. Our results call for health systems to assess for inequities with parking fees at WCVs, and to examine how removing this barrier could improve health equity. 

Deniz Cataltepe CVDeniz Cataltepe CV.pdf