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Doctors hard to find for patients in Massachusetts' first for-profit health plan
Date:8/4/2010

The first for-profit insurance company approved to offer government-subsidized coverage under Massachusetts' health reform has dangerously restricted access to primary care, according to data reported in Thursday's (Aug. 5) New England Journal of Medicine. Researchers say the findings raise troubling concerns about the Obama administration's new health law, which is modeled after the Massachusetts plan.

Three Harvard-affiliated physicians report that out of a list of 326 doctors identified as members of the provider network of CeltiCare, a for-profit insurer contracted by the state of Massachusetts to take over coverage of about 30,000 legal immigrants (and, more recently, low-income citizens), only 217 were non-duplicate adult primary care providers. Of these 217 doctors, 25 percent could not be reached by telephone.

Of those primary care doctors who were reachable by telephone, only 37 percent, or 60 providers, said they were accepting new CeltiCare patients. In those cases, the average wait time for an appointment was 33 days, even though the patient was described as having a chronic illness like diabetes or hypertension.

Moreover, although many of the patients who had been forced into the CeltiCare plan don't speak English, only 38 of the doctors who were accepting new patients had any form of translation services.

The plan's failure to provide adequate access to doctors for its members raises grave concerns not only about Massachusetts' reform, but also about the recently enacted national reform, the researchers say. The national plan closely mirrors Massachusetts' reform, but relies far more heavily on for-profit insurers.

The report points out that even when patients have insurance, profit-driven plans may discourage them from getting the care they need by "rationing by inconvenience."

The data appears in a letter titled "Immigrants' experience with publicly funded private health insurance" i
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Contact: Mark Almberg
mark@pnhp.org
312-782-6006
Physicians for a National Health Program
Source:Eurekalert

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