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Specialists Often Turn Away Kids With Public Insurance: Report
Date:6/16/2011

By Maureen Salamon
HealthDay Reporter

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 problems.

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 specialty care.

"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."

More information

Learn more about the Children's Health Insurance Program (CHIP).

SOURCES: Karin Rhodes, M.D., director, division of emergency care policy research, department of emergency medicine, University of Pennsylvania, Philadelphia; Edward Schor, M.D., vice president, state health policy and practices, Commonwealth Fund, New York City; June 16, 2011, New England Journal of Medicine


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