Secret shopper study highlights student research experiences

More than 30 undergrads worked on Affordable Care Act marketplace project

Kristen Mitchell
Thomas Elton presents a poster during CPH Poster Day

Thomas Elton spoke about the secret shopper project at CPH Poster Day in April.

Long waits for appointments, out-of-date information about health care providers and the risk of discriminatory treatment are just a few of the hurdles facing Americans seeking adequate, accessible health care. A “secret shopper” project co-led by College of Public Health Associate Professor Wendy Xu aims to quantify these challenges and expose students to research designed to better understand and, ultimately, improve health care.

The secret shopper project mimics the real-life experiences of patients who access care through the Affordable Care Act marketplace. The goal is to assess administrative burdens patients face when using the medical marketplace provider directory and determine if people are treated differently based on their perceived race or demographic data.

Xu recruited more than 30 Ohio State undergraduate students from different immigrant communities and various racial and ethnic backgrounds to work on the project. Using the provider directory, student researchers pose as potential patients calling a covered provider to ask for appointments. The research team is also working to find out if potential patients are being treated differently based on their perceived race or background — documenting how often they are put on hold, for example, to determine if discriminatory patterns emerge. 

“We wanted this to be an opportunity to expose students to health care system research focused on equity in health care access, and to open doors to undergraduate students who are interested in research,” Xu said of the project, which is supported by the Robert Wood Johnson Foundation.

Wendy Xu poses with students
Associate Professor Wendy Xu poses with student researchers working on the secret shopper project.

Thomas Elton, a PhD student in health services management and policy and a graduate research assistant (GRA) on the project, is a core member of the research team. In addition to supporting research tasks including statistical analysis and literature review, Elton is a highly valued mentor to undergraduate student researchers involved in the project, Xu said.

“We learn about the ACA in the classroom. We learn about the marketplace and that navigating the health care system is difficult,” Elton said. “With this project we are experiencing that first-hand, and it backs up what we learn in class.”

The GRA experience has helped Elton develop project management skills and discover a passion for finding answers through the research process. Elton presented a poster about the project at CPH Poster Day in April.

As a Navy veteran who receives U.S. Department of Veterans Affairs coverage, Marisa Davis BSPH ’23, wanted to better understand the systemic barriers in civilian health care access.

“One of my classes was an international and domestic health care class. In that class, I was able to see those pieces and really understand it because of this research,” said Davis, who started working in Xu’s lab in May 2022.

“I’m going on for my master’s in public health and I’ve already begun talking to people at the graduate program I’ll be attending about pursing research there too because I really enjoyed so much getting to be a part of it,” she said.

Maria Gallo, associate dean for research, said getting involved in research is a great way for students to apply theoretical knowledge they learn in the classroom to real-life situations and gain deeper understanding of both the research methods and the subject matter.

“Public health is also a collaborative field, and conducting research helps students gain experience in working on a team,” she said. “Overall, having this experience can make students more competitive for jobs when they graduate.”

Xu is recruiting student researchers for a similar project focused on Medicaid managed care access launching this fall.