Auditing Access to Specialty Care for Children with Public Insurance

Bisgaier, Joanna; Rhodes, Karin V.

doi:10.1056/nejmsa1013285

Cited by 286 publications

(252 citation statements)

References 32 publications

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“…We decided a priori to include age, sex, race, ethnicity, region, urban status, and year in the model, as they have been previously demonstrated to be associated with differences in both ED and psychiatric care. 3,6,7,11,12,16,[19][20][21][22][23][24] For the length of stay (LOS) analysis as our secondary outcome, we tested for trend the median visit length. Median LOS is used in place of the mean LOS as values were not normally distributed.…”

Section: Discussionmentioning

confidence: 99%

“…9,10 Outpatient access to psychiatric care for children may be limited, especially in certain at-risk socioeconomic groups. 6,[11][12][13][14] While the PECARN study and several Canadian studies have suggested that socioeconomic factors may be associated with high odds of ED psychiatric visits, 3,12,[15][16][17] no study has evaluated these factors using nationally representative United States data. The specific focus of this study was on sociodemographic factors and their effect on odds of ED visits.…”

mentioning

confidence: 99%

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Trends in Pediatric Visits to the Emergency Department for Psychiatric Illnesses

Pittsenbarger

Mannix

2013

Academic Emergency Medicine

125

106

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Objectives: While recent studies have demonstrated an overall increase in psychiatric visits in the emergency department (ED), none have focused on a nationally representative pediatric population. Understanding trends in pediatric psychiatric ED visits is important because of limited outpatient availability of pediatric specialists, as well as long wait times for psychiatric appointments. The study aim was to evaluate the trends in ED psychiatric visits for children between 2001 and 2010 with comparison by sociodemographic characteristics.Methods: This was a retrospective, cross-sectional analysis of ED psychiatric visits for children < 18 years of age using the National Hospital Ambulatory Medical Care Survey (NHAMCS). Visits were identified by International Classification of Diseases, Ninth Revision (ICD-9), codes. Outcome measures included frequency of visits for children with psychiatric diagnosis codes and odds and adjusted odds of psychiatric visits controlling for temporal, demographic, and geographic factors.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Trends in Pediatric Visits to the Emergency Department for Psychiatric Illnesses

Pittsenbarger

Mannix

2013

Academic Emergency Medicine

125

106

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“…8,14 Audit studies, a well-established method of testing for discrimination in labour and housing markets, [15][16][17] have been used in the United States to show that Medicaid recipients and patients who are uninsured encounter substantial barriers to care. [18][19][20][21] However, these effects may be due to the economic incentive of differing levels of reimbursement, rather than discrimination on the basis of socio economic status itself.…”

Section: Discussionmentioning

confidence: 99%

The effect of socioeconomic status on access to primary care: an audit study

Olah

Gaisano

Hwang

2013

CMAJ

120

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“…Even when providers do accept Medicaid insurance, access and outcome disparities will remain. At least one study demonstrated that children with Medicaid faced significant delays in accessing specialty care even when specialists accepted Medicaid, compared with those with private insurance (41). Similarly, although outcomes for those with Medicaid are generally better than for the uninsured, Medicaid beneficiaries continue to experience delays in diagnoses (lung cancer [2]) and increased mortality (cancer [2], critical care [28]) when compared with those with private health insurance.…”

Section: Medicaid and Access To Specialty Carementioning

confidence: 99%

Medicaid Expansion under the Affordable Care Act. Implications for Insurance-related Disparities in Pulmonary, Critical Care, and Sleep

2014

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The Affordable Care Act was intended to address systematic health inequalities for millions of Americans who lacked health insurance. Expansion of Medicaid was a key component of the legislation, as it was expected to provide coverage to low-income individuals, a population at greater risk for disparities in access to the health care system and in health outcomes. Several studies suggest that expansion of Medicaid can reduce insurance-related disparities, creating optimism surrounding the potential impact of the Affordable Care Act on the health of the poor. However, several impediments to the implementation of Medicaid's expansion and inadequacies within the Medicaid program itself will lessen its initial impact. In particular, the Supreme Court's decision to void the Affordable Care Act's mandate requiring all states to accept the Medicaid expansion allowed half of the states to forego coverage expansion, leaving millions of low-income individuals without insurance. Moreover, relative to many private plans, Medicaid is an imperfect program suffering from lower reimbursement rates, fewer covered services, and incomplete acceptance by preventive and specialty care providers. These constraints will reduce the potential impact of the expansion for patients with respiratory and sleep conditions or critical illness. Despite its imperfections, the more than 10 million low-income individuals who gain insurance as a result of Medicaid expansion will likely have increased access to health care, reduced out-of-pocket health care spending, and ultimately improvements in their overall health.

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Auditing Access to Specialty Care for Children with Public Insurance

Abstract: 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.

Cited by 286 publications

References 32 publications

Trends in Pediatric Visits to the Emergency Department for Psychiatric Illnesses

Trends in Pediatric Visits to the Emergency Department for Psychiatric Illnesses

The effect of socioeconomic status on access to primary care: an audit study

Medicaid Expansion under the Affordable Care Act. Implications for Insurance-related Disparities in Pulmonary, Critical Care, and Sleep

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