WEDNESDAY, June 15 (HealthDay News) -- Undercover research in
Illinois reveals that medical specialists refuse appointments to
publicly insured children with potentially urgent conditions six
times more often than privately insured kids with identical health
Posing as mothers of children with seven common health
conditions -- including diabetes, uncontrolled asthma and severe
depression -- research assistants phoned 273 clinics twice, a month
apart, to investigate the impact of insurance status on the
practices' decision to schedule an appointment.
Two-thirds of kids with public insurance were unable to get a
doctor's appointment, compared to 11 percent of privately insured
children. Kids covered by Medicaid and Children's Health Insurance
Program (CHIP) who did receive appointments also faced far longer
average wait times -- 42 days to see a specialist compared to 20
days for kids with private insurance.
"Early specialist intervention can make a difference in the long-term outcome. The study shows equal access doesn't exist," said senior study author Dr. Karin V. Rhodes, director of emergency care policy research in the department of emergency medicine at the University of Pennsylvania. "These are fairly urgent conditions, and at least as a parent, I would want to get the kid in earlier than three weeks -- and that was the wait for privately insured children."
The study is published June 16 in the
New England Journal of Medicine.
Federal law requires that Medicaid recipients have the same
access to medical care as the general population in their
community. Overall, only 34 percent of callers in the study with
Medicaid-insured children were able to secure an appointment,
compared to 89 percent of callers reporting Blue Cross Blue Shield
PPO insurance plans.
In more than half of the calls, the "mothers" were asked for
insurance information before being told whether an appointment
could be offered. The type of insurance coverage was the first
question asked in just over half the calls.
Dr. Edward Schor, vice president of state health policy and
practices for the Commonwealth Fund, which supports independent
research on health care issues, said he was impressed by the array
of illnesses presented for specialists' consideration. Many of
them, including seizures, fractures that could affect bone growth,
and obstructed breathing during sleep, would either get
catastrophically worse or resolve completely by the end of a three-
to six-week wait for care, he said.
"The study seems to be well-done," Schor said. "Most of what we've had in the past seemed to be anecdotal."
Prior research indicated that low Medicaid reimbursement rates
affect doctors' decisions about accepting patients with public
insurance. But Rhodes said the culture and mission of the health
systems in which the physicians work may have played a larger role
in the study results.
She also complimented the state of Illinois for being the first
to measure access to care and recommended every state follow suit,
particularly if considering cutting Medicaid benefits.
"Specialists frequently work within a health system, and most specialists are hospital-affiliated, so I think it's a system issue," Rhodes said. "Providers told us they are under pressure from their institutions to maximize reimbursement."
The practice doesn't appear to be limited to physicians, either.
In another study, recently published in
Pediatrics, Rhodes reported that dentists in Illinois are far more willing to provide emergency care to children with private insurance than to kids with public insurance.
Schor said access to health care has been documented to differ
by states, so the problem is not just in Illinois and not only with
"I think the underlying issue is financial," he said, adding that procedural hassles can also affect how many publicly insured patients doctors treat. "If, as this study suggests, the problem has a strong financial root to it ... it's not just a question of if the specialist has open appointments."
Learn more about the
Health Insurance Program (CHIP).