The effect of insurance type on trauma patient access to psychiatric care under the Affordable Care Act

Wiznia, Daniel H.; Maisano, Julianna; Kim, Chang Yeon; Zaki, Theodore; Lee, Ho-Chang; Leslie, Michael

doi:10.1016/j.genhosppsych.2016.12.006

Cited by 15 publications

(14 citation statements)

References 30 publications

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“…The trends identified in our study reflect similar findings in other medical fields, including primary care 28 and specialties like orthopedics, 29 endocrinology, 30 and psychiatry 31 that have also demonstrated that patients with Medicaid are less successful in obtaining appointments. These studies had similar experimental designs to the present one, utilizing simulated patient callers with a specific common clinical complaint.…”

Section: Discussionsupporting

confidence: 86%

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Comparison of Access to Eye Care Appointments Between Patients With Medicaid and Those With Private Health Care Insurance

Lee¹,

Chen

Varadaraj³

et al. 2018

JAMA Ophthalmol

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Importance While poorer populations have more eye problems, it is not known if they face greater difficulty obtaining eye care appointments. Objective To compare rates of obtaining eye care appointments and appointment wait times for those with Medicaid and private insurance. Design In this prospective observational study, researchers telephoned a randomly selected sample of vision care providers in Michigan and Maryland stratified by neighborhood (urban vs. rural) and provider type (ophthalmologist vs. optometrist) to request the first available appointment. Appointments were sought for an adult needing a diabetic eye exam and a child requesting a routine eye exam for a failed vision screening. Researchers called each practice twice, approximately 2–7 days apart, once requesting an appointment for a patient with Medicaid, and the other for a patient with BlueCross BlueShield (BCBS), and asked if 1) the insurance was accepted, and if so, 2) when the earliest available appointment was. Setting Eye clinics throughout Maryland and Michigan. Participants Random sample of 330 ophthalmology and optometry practices. Main Outcomes and Measures Rate of successfully made appointments and mean wait time for the first available appointment. Results A total of 330 eye care providers were contacted. The sample consisted of ophthalmologists (50%) and optometrists (50%) located in Maryland (53%) and Michigan (47%). The rates of successfully obtaining appointments among callers said to have Medicaid and BCBS were 62% [56%,67%] and 79% [75%,84%] (p<0.001), respectively, for adults, and 45% [40%,51%] and 63% [57%,68%] (p<0.001), respectively, for children. Mean wait time did not vary significantly between BCBS and Medicaid for both adult and child. Factors associated with decreased odds of obtaining an appointment for adults and children included Medicaid insurance, appointment with an ophthalmologist and practice location in Maryland. Conclusions and Relevance Callers were less successful in trying to obtain eye care appointments with Medicaid than with BCBS, suggesting a disparity in access to eye care based on insurance status, though confounding factors may have also contributed to this finding. Improving access to eye care professionals for those with Medicaid may improve health outcomes and decrease healthcare spending in the long term.

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Section: Discussionsupporting

confidence: 86%

“…Similar studies in primary care, 28 orthopedics, 29 endocrinology, 30 and psychiatry 31 have demonstrated significant differences in patient access by insurance type. While we have shown similar findings using administrative and claims data, 32 we sought to confirm these findings through a more direct means.…”

Section: Methodsmentioning

confidence: 69%

Comparison of Access to Eye Care Appointments Between Patients With Medicaid and Those With Private Health Care Insurance

Lee¹,

Chen

Varadaraj³

et al. 2018

JAMA Ophthalmol

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“…Table S1 in Supplemental Material summarizes the study characteristics of the 34 articles included in this review. 16-49 In total, the 34 studies represented 21,601 calls to provider offices requesting an appointment for Medicaid and private insurance scenarios, of which 63% resulted in successful scheduling. Of 11,387 calls with private insurance, 80% of calls successfully led to appointments, while 45% of 10 214 calls with Medicaid resulted in none.…”

Section: Resultsmentioning

confidence: 99%

Medicaid Patients Have Greater Difficulty Scheduling Health Care Appointments Compared With Private Insurance Patients: A Meta-Analysis

Hsiang

Lukasiewicz

Gentry

et al. 2019

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Medicaid patients are known to have reduced access to care compared with privately insured patients; however, quantifying this disparity with large controlled studies remains a challenge. This meta-analysis evaluates the disparity in health services accessibility of appointments between Medicaid and privately insured patients through audit studies of health care appointments and schedules. Audit studies evaluating different types of outpatient physician practices were selected. Studies were categorized based on the characteristics of the simulated patient scenario. The relative risk of appointment availability was calculated for all different types of audit scenario characteristics. As a secondary analysis, appointment availability was compared pre- versus post-Medicaid expansion. Overall, 34 audit studies were identified, which demonstrated that Medicaid insurance is associated with a 1.6-fold lower likelihood in successfully scheduling a primary care appointment and a 3.3-fold lower likelihood in successfully scheduling a specialty appointment when compared with private insurance. In this first meta-analysis comparing appointment availability between Medicaid and privately insured patients, we demonstrate Medicaid patients have greater difficulty obtaining appointments compared with privately insured patients across a variety of medical scenarios.

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“…[2,11] While we have demonstrated increased access to total joint arthroplasty in this two-state comparison, access to specialty care remains an issue for other specialties. [22,23] Additionally, we have not analyzed specific barriers presented to Medicaid beneficiaries attempting to access services, such as narrower networks of providers willing to see patients with Medicaid. [7] Our analysis adjusted for number of orthopaedic surgeons within each county but because we do not have providerlevel data, we are unable to evaluate whether Medicaid expansion resulted in changes in surgeon willingness to provide surgery to Medicaid beneficiaries.…”

Section: Discussionmentioning

confidence: 99%

Two-State Comparison of Total Joint Arthroplasty Utilization Following Medicaid Expansion

Brown

Maryam

et al. 2019

The Journal of Arthroplasty

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BACKGROUND: While Medicaid expansion has improved access to primary care services, its impact on surgical specialty utilization remains unclear. To determine whether Medicaid expansion was associated with increased compared utilization rates of total hip arthroplasty (THA) and total knee arthroplasty (TKA) in Illinois (which expanded Medicaid) relative to Missouri (which did not expand Medicaid). METHODS: Using administrative data sources, we analyzed 374,877 total hospitalizations (236,333 in Illinois and 138,544 in Missouri) for THA/TKA from 2011-2016 (Illinois' Medicaid expansion date: 1/1/2014). RESULTS: The percentage of THA/TKA funded by Medicaid in Illinois was 2.4% in 2013 and 3.9% in 2016 (Missouri-2013: 2.7%; 2016: 2.6%). A difference-indifference analysis (adjusted for patient age and sex, county-level Area Deprivation Index, and number of orthopaedic *

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The effect of insurance type on trauma patient access to psychiatric care under the Affordable Care Act

Cited by 15 publications

References 30 publications

Comparison of Access to Eye Care Appointments Between Patients With Medicaid and Those With Private Health Care Insurance

Comparison of Access to Eye Care Appointments Between Patients With Medicaid and Those With Private Health Care Insurance

Medicaid Patients Have Greater Difficulty Scheduling Health Care Appointments Compared With Private Insurance Patients: A Meta-Analysis

Two-State Comparison of Total Joint Arthroplasty Utilization Following Medicaid Expansion

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