Tamara Beetham, PhD, MPH

Research

Measuring real-world access barriers

Audit and survey methods that capture what patients experience when seeking care.

Administrative claims data describe who gets care but not who is turned away. Using secret-shopper audit designs and national facility surveys, I measure the supply side directly: which providers accept which patients, at what wait times, at what cost, and with what evidence-based options on offer. The methods began with addiction treatment access and now extend to primary care.

A persistent gap in health services research is that we observe the patients who successfully receive care but rarely those who could not get a foot in the door. Audit methods address that gap by measuring provider-side behavior directly: appointment availability, payer acceptance, wait times, intake practices, and whether evidence-based treatments are offered to the patients who call. My work has applied this approach across buprenorphine prescribers, residential addiction treatment facilities, adolescent treatment programs, psychiatric hospitals, and primary care for Medicare beneficiaries. Companion work uses national facility-level data to characterize the same access landscape at scale. Recent work extends these methods to general medical care, where consolidation and workforce shortages may be reshaping access in ways that are not fully visible in claims data alone.

Representative work