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Current Research Portfolio
My current research examines access to contested healthcare across multiple levels of governance. Two studies analyze state policy, federalism, and administrative structure. Three companion conceptual articles examine the prospective user’s decision to approach an institution, the discretion exercised by trusted religious gatekeepers, and the governance of referrals across organizational networks.
Together, these projects trace how law, institutional identity, administrative capacity, and organizational design shape access before a person enters care, during the initial referral process, and across the wider service system.
Manuscripts Submitted for Publication
Manuscripts Submitted for Publication
Empirical and Methodological Studies
Empirical and Methodological Studies
Primrose, H. M. (2026). Religious health systems, state policy, and LGBTQ+ access: A state-level cumulative exposure index. Manuscript submitted for publication.
Contribution: This article constructs a state-level Cumulative Exposure Index that combines religious hospital concentration with LGBTQ+ health-policy restrictions, insurance gaps, benefit exclusions, and weak policy protections to identify jurisdictions where administrative review may be most warranted.
Boundary/use: The index is an administrative triage tool, not a measure of patient-level harm, discrimination, institutional performance, or causation, and should be used to prioritize service disclosure, network-adequacy review, merger oversight, referral integrity, and complaint monitoring.
Primrose, H. M. (2026). Beyond authorization: Administrative usability in medical cannabis federalism in Kansas and Colorado under a common federal regime. Manuscript submitted for publication.
Contribution: This research note distinguishes legal authorization from administrative usability by showing how contrasting state policy environments shape professional guidance, documentation, monitoring, referral, and institutional learning under a shared federal framework.
Boundary/use: The comparison generates administrative mechanisms rather than causal estimates and does not assess clinical effectiveness or patient outcomes; it is intended to help policymakers evaluate whether a legally permitted intervention can actually be discussed, documented, monitored, and integrated into ordinary practice.
Conceptual Frameworks
Conceptual Frameworks
Primrose, H. M. (2026). Before the appointment: Administrative burden, institutional trust, and the governance of LGBTQ+ access to faith-affiliated care. Manuscript submitted for publication.
Contribution: This article defines approachability as a prospective judgment about whether contacting a particular organization for a particular service appears sufficiently intelligible, safe, agency-preserving, and reversible, extending anticipated administrative burden to the decision whether to initiate contact at all.
Boundary/use: The framework does not estimate prevalence or causal effects and does not presume that faith-affiliated organizations are categorically safe or unsafe; it is designed to guide practice-specific disclosure, organizational consistency, realistic fallback pathways, and independent accountability.
Primrose, H. M. (2026). Nonstate religious gatekeeping in hybrid health systems: Discretion, capacity, and LGBTQ+ referral. Manuscript submitted for publication.
Contribution: This article develops a bounded administrative theory of nonstate religious gatekeeping by identifying five discretionary mechanisms and distinguishing readiness at the individual, organizational, and network levels.
Boundary/use: The framework does not treat clergy as conventional street-level bureaucrats, infer capacity from religious identity or goodwill, or report human-participant findings; it provides due-diligence criteria for agencies, hospitals, and nonprofits that rely on trusted religious actors within service pathways.
Primrose, H. M. (2026). Referral integrity in religiously affiliated care networks: Governance and accountability in morally plural systems. Manuscript submitted for publication.
Contribution: This article makes referral integrity the central unit of network governance and compares participant-governed, lead-organization, and network-administrative forms against seven required functions for continuity, accountability, and service-user protection.
Boundary/use: The framework is conceptual, has not been tested as an intervention, and does not claim that a network administrative organization is universally superior; it is intended to help organizations select and evaluate governance arrangements based on network scale, heterogeneity, risk, and accountability needs.
Dissertations and Doctoral Research
Dissertations and Doctoral Research
Primrose, H. M. (2026). A qualitative study of medical cannabis policy for multiple sclerosis in Kansas and Colorado [Doctoral dissertation, Walden University]. Walden University ScholarWorks.
Primrose, H. M. (2022). Organizational capacity and service delivery barriers in behavioral health access: Hospital referral systems and community-based care for LGBTQ+ patients [Doctoral project]. Liberty University.
Public Writing
Public Writing
ORCID
ORCID
ORCID: 0009-0004-1412-8600
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