2012-03-27 Reuters Health - Getting a doctor's appointment tougher on Medicaid

[Minuteman]

Might add weight to the argument that there are higher priority areas for the Medicaid program than funding medically-unnecessary circumcision of male minors.

http://www.nlm.nih.gov/medlineplus/n...ry_123455.html Accessed: 2012-03-28. Archived by WebCite at http://www.webcitation.org/66VtOvSri

Excerpts:

Americans on Medicaid have a harder time getting a prompt doctor's appointment, which may help explain why some end up going to the ER, a new study finds.

The problem is likely to grow, researchers say, as more people go on Medicaid as part of national healthcare reform. So simply expanding coverage may not be enough to improve low-income Americans' access to primary care.

"Insurance coverage does not necessarily mean better access," said senior researcher Dr. Adit A. Ginde, of the University of Colorado School of Medicine.
...
Some state Medicaid programs have taken controversial steps to prevent "unnecessary" ER trips -- like limiting the types of diagnoses it will cover if a patient goes to the ER.

But even if an injury or illness is not an emergency, there are many conditions that need timely attention, Ginde said. So Medicaid recipients need somewhere to go.

"The problem may actually get worse," he noted, "if we keep working with the same resources, but the demand increases."

PubMed citation and abstract for the cited study:

Cheung PT, Wiler JL, Lowe RA, Ginde AA (2012) National Study of Barriers to Timely Primary Care and Emergency Department Utilization Among Medicaid Beneficiaries Ann Emerg Med. 2012 Mar 12. [Epub ahead of print] Abstract available at http://www.ncbi.nlm.nih.gov/pubmed/22418570

STUDY OBJECTIVE: We compare the association between barriers to timely primary care and emergency department (ED) utilization among adults with Medicaid versus private insurance.

METHODS: We analyzed 230,258 adult participants of the 1999 to 2009 National Health Interview Survey. We evaluated the association between 5 specific barriers to timely primary care (unable to get through on telephone, unable to obtain appointment soon enough, long wait in the physician's office, limited clinic hours, lack of transportation) and ED utilization (≥1 ED visit during the past year) for Medicaid and private insurance beneficiaries. Multivariable logistic regression models adjusted for demographics, socioeconomic status, health conditions, outpatient care utilization, and survey year.

RESULTS: Overall, 16.3% of Medicaid and 8.9% of private insurance beneficiaries had greater than or equal to 1 barrier to timely primary care. Compared with individuals with private insurance, Medicaid beneficiaries had higher ED utilization overall (39.6% versus 17.7%), particularly among those with barriers (51.3% versus 24.6% for 1 barrier and 61.2% versus 28.9% for ≥2 barriers). After adjusting for covariates, Medicaid beneficiaries were more likely to have barriers (adjusted odds ratio [OR] 1.41; 95% confidence interval [CI] 1.30 to 1.52) and higher ED utilization (adjusted OR 1.48; 95% CI 1.41 to 1.56). ED utilization was even higher among Medicaid beneficiaries with 1 barrier (adjusted OR 1.66; 95% CI 1.44 to 1.92) or greater than or equal to 2 barriers (adjusted OR 2.01; 95% CI 1.72 to 2.35) compared with that for individuals with private insurance and barriers.

CONCLUSION: Compared with individuals with private insurance, Medicaid beneficiaries were affected by more barriers to timely primary care and had higher associated ED utilization. Expansion of Medicaid eligibility alone may not be sufficient to improve health care access.