NDLI: Auditing access to specialty care for children with public insurance.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Rhodes, Karin V. Bisgaier, Joanna
Spatial Coverage	United States Illinois
Description	Author Affiliation: Bisgaier J ( School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA 19104, USA.)
Abstract	BACKGROUND: Health care reform has expanded eligibility to public insurance without fully addressing concerns about access. We measured children's access to outpatient specialty care to identify disparities in providers' acceptance of Medicaid and the Children's Health Insurance Program (CHIP) versus private insurance. METHODS: Between January and May 2010, research assistants called a stratified, random sample of clinics representing eight specialties in Cook County, Illinois, which has a high proportion of specialists. Callers posed as mothers of pediatric patients with common health conditions requiring outpatient specialty care. Two calls, separated by 1 month, were placed to each clinic by the same person with the use of a standardized clinical script that differed by insurance status. RESULTS: We completed 546 paired calls to 273 specialty clinics and found significant disparities in provider acceptance of Medicaid-CHIP versus private insurance across all tested specialties. Overall, 66% of Medicaid-CHIP callers (179 of 273) were denied an appointment as compared with 11% of privately insured callers (29 of 273) (relative risk, 6.2; 95% confidence interval [CI], 4.3 to 8.8; P<0.001). Among 89 clinics that accepted both insurance types, the average wait time for Medicaid-CHIP enrollees was 22 days longer than that for privately insured children (95% CI, 6.8 to 37.5; P=0.005). CONCLUSIONS: We found a disparity in access to outpatient specialty care between children with public insurance and those with private insurance. Policy interventions that encourage providers to accept patients with public insurance are needed to improve access to care.
ISSN	00284793
Issue Number	24
Volume Number	364
e-ISSN	15334406
Journal	New England Journal of Medicine
Language	English
Publisher	Massachusetts Medical Society (United States)
Publisher Date	2011-06-16
Publisher Place	United States
Access Restriction	Subscribed
Subject Keyword	Child Health Services Statistics & Numerical Data Health Services Accessibility Insurance Coverage Insurance, Health Medicaid Specialization Child Clinical Audit Health Care Surveys Humans Illinois Patient Protection And Affordable Care Act United States Journal Article Research Support, Non-U.S. Gov't Medicine
Content Type	Text
Resource Type	Article
Subject	Medicine

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