Medicaid and uninsured patients are disadvantaged in access to care and are disproportionately Black and Hispanic. Using a national audit of primary care physicians, we examine the relationship between state Medicaid fees for primary care services and access for Medicaid, Medicare, uninsured, and privately insured patients who differ by race/ethnicity and sex. We found that states with higher Medicaid fees had higher probabilities of appointment offers and shorter wait times for Medicaid patients, and lower probabilities of appointment offers and longer wait times for uninsured patients. Appointment offers and wait times for Medicare and privately insured patients were unaffected by Medicaid fees. At mean state Medicaid fees, our analysis predicts a 27-percentage-point disadvantage for Medicaid versus Medicare in appointment offers. This decreases to 6 percentage points when Medicaid and Medicare fees are equal, suggesting that permanent fee parity with Medicare could eliminate most of the disparity in appointment offers for Medicaid patients. The predicted decrease in the disparity is smaller for Black and Hispanic patients than for White patients. Our research highlights the importance of considering the effects of policy on nontarget patient groups, and the consequences of seemingly race-neutral policies on racial/ethnic and sex-based disparities.
The authors evaluated principles of macroeconomics textbooks for readability using Coh-Metrix, a computational linguistics tool. Additionally, they conducted an experiment on Amazon's Mechanical Turk Web site in which participants ranked the readability of text samples. There was a wide range of scores on readability indexes both between textbooks and within textbooks. Results from the Mechanical Turk experiment revealed that the Flesch Reading Ease Index does not predict which samples readers will prefer, but readers do prefer samples that are thematically similar, as identified by Latent Semantic Analysis. There were differences in the responses of native and non-native-but-proficient English speakers to the text samples, suggesting that the intended audience is an important determinant of readability.
Background and purpose
Access to primary care remains a problem for a substantial portion of the U.S. population, and is predicted to worsen due to an aging population and the increasing burden of chronic diseases. Better integration of nurse practitioners (NPs) into the primary care workforce is a possible solution. We examine offers of appointments with NPs if a requested primary care physician is unavailable.
Methods
Data are from a 2013 audit (simulated patient) study requesting appointment information from a national random sample of primary care physicians. Outcome variables include appointment offers, wait‐to‐appointment times, and appointment offers with alternate providers, including NPs.
Conclusions
Of 922 calls to primary care physicians serving the general adult population, 378 (41%) offered appointments with the requested physician. Alternate providers were offered by 63 (7%), including nine offers with NPs (<1%). Mean wait‐to‐appointment for NPs (3.6 days) was statistically significantly shorter (p‐values < .01) than for requested physicians (22.5 days) or non‐NP alternate providers (23.9 days).
Implications for practice
NPs are an important part of the primary care workforce, and new patients seeking primary care physicians may substantially reduce their wait times if an NP is offered.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.