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.