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

efore 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 procedur
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