Brian Klepper
This brief summary of a New England Journal article caught my attention yesterday.
An audit study in which research assistants posing as mothers made paired calls to the same clinic and attempted to schedule an appointment for a child needing specialty care, one month apart, with insurance status as the only variable, found:
- 54% of the calls involved a request for information about the child’s insurance type before the caller was told whether an appointment could be scheduled; the type of insurance coverage was the first question asked in 52% of these calls.
- 66% of those who mentioned Medicaid-CHIP (Children’s Health Insurance Program) were denied appointments, compared with 11% percent who said they had private insurance.
- In 89 clinics that accepted both kinds of patients, the waiting time for callers who said they had Medicaid was an average of 22.1 days longer than for those who said they had private insurance.
As unfair as this may seem, one can hardly blame the physician and practice managers who, in an increasingly difficult economic environment, know that seeing Medicaid patients will end up costing them more than they receive.
This news echoes a more dire article, The Most Difficult Budget Year, by Randy Edwards in Hospitals and Health Systems, detailing the nationwide fallout of the budget crisis Medicaid and the curtailing of other programs, particularly community health centers, for the truly needy.
If there is a silver lining, and it is certainly not there for those with current needs, it is that this is the edge of the health care cost crisis’ impact. As more health programs hit a financial wall, the pressure to actually innovate and manage the overwhelmingly wasteful processes in health care will get more traction and ultimately change the ways that care is delivered.
Care And Cost 
A few of thoughts: 1) I am surprised that the average difference in wait time was only 22 days. That is much less than I would have suspected. 2) In some ways, these kids with Medicaid are lucky. Think of kids without any insurance or Medicaid. Try making an appointment for a kid without any insurance. 3) Think about factoring adults with Medicaid or the adult uninsured into the equations and the numbers would rapidly grow quite dismal. 4) Healthcare reform that leads to more patients entering/trying to enter the system is not going to fare well without a more available system and many more primary care and specialty care providers. 5) Having personally scheduled doctor appointments for myself and my child, I know that the majority of the time the first question a medical office asks me is “What type of insurance coverage do you have? Do you require prior authorization to see us?” It always sounds crass, but as a practicing physician I understand exactly why this information is so crucial and intricate to the entire process of establishing care at an office. We are all victims of our insane system.