Measuring real-world access barriers | Tamara Beetham, PhD, MPH

Using secret shopper audits and national facility surveys, I capture treatment availability, wait times, cost, and quality from the perspective of patients seeking care. These studies have included buprenorphine prescribers, residential addiction treatment programs for adults and adolescents, psychiatric hospitals, and primary care clinics serving Medicare patients. My job market paper used AI voice agents to call nearly 15,000 primary care clinics.

In an audit study, callers contact providers as prospective patients and record appointment availability, payer acceptance, wait times, intake practices, and whether evidence-based treatments are offered. Claims data rarely contain this information because they include only patients who received care. Companion work uses national facility-level data to describe treatment availability across the US. My current audit work focuses on access for new patients in primary care, where consolidation and workforce shortages may be affecting appointment availability.

Representative work

Medicare Appointment Availability and Wait Times Vary Considerably Across Four Large US Urban Markets

Beetham T, Marsh T, Barnett ML, Aaron RM, Greenberg E, Do Alexandra, Zhu JM

Health Affairs Scholar, 4(3), 2026.

Audit study of Medicare primary care across four major US urban markets; access varied widely by city and by organizational structure.

Availability of Medications for Opioid Use Disorder in US Psychiatric Hospitals

Beetham T*, Cohen SM*, Fiellin DA, Muvvala SB

JAMA Network Open, 7(11):e2444679, 2024.

National survey of US psychiatric hospitals on the availability of FDA-approved medications for opioid use disorder.

Adolescent Residential Addiction Treatment in the US: Uneven Access, Waitlists, and High Costs

King C, Beetham T, Smith N, Englander H, Button D, Brown PCM, Hadland SE, Bagley SM, Wright OR, PT Korthuis, Cook R

Health Affairs, 43(1):64-71, 2024.

Audit of US adolescent residential addiction facilities documenting waitlists, daily costs, and large up-front payments.

Treatments Used Among Adolescent Residential Addiction Treatment Facilities in the US, 2022

King C, Beetham T, Smith N, Englander H, Hadland SE, Bagley SM, PT Korthuis

JAMA, 329(22):1983–1985, 2023.

Companion research letter on which evidence-based treatments adolescent residential facilities offer.

Admission Practices and Cost of Care for Opioid Use Disorder at Residential Addiction Treatment Programs in the US

Beetham T, Saloner B, Gaye M, Wakeman SE, Frank RG, Barnett M

Health Affairs, 2021.

Audit of US residential addiction programs documenting admission offers before clinical evaluation, large up-front payments, and aggressive recruitment practices, including at accredited and state-licensed facilities.

Therapies Offered at Residential Addiction Treatment Programs in the US

Beetham T, Saloner B, Gaye M, Wakeman SE, Frank RG, Barnett M

JAMA, 2020.

Research letter on the evidence-based therapies offered at residential addiction programs in the US.

Access to office-based buprenorphine treatment in areas with high opioid-related mortality: an audit study

Beetham T, Saloner B, Wakeman SE, Gaye M, Barnett M

Annals of Internal Medicine, 2019.

Audit of office-based buprenorphine access for uninsured and Medicaid-covered patients in six US jurisdictions with high opioid-related mortality.