Access to primary care more difficult for Medicaid patients

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1.  Getting a primary care appointment as a new patient was easier as a privately insured patient than as a Medicaid patient. 

2.  Wait times for all patients were similar. 

Evidence Rating Level: 2 (Good)      

Study Rundown:  The Patient Protection and Affordable Care Act (ACA) is expected to improve access to healthcare for millions of people.  However, the ability of the current primary care infrastructure to absorb such a large influx of patients is not well known.  The authors in this study used a simulated patient methodology to estimate the ease of making a new patient primary care appointment and the variability in doing so, depending on the insurance status.  They found that patients with Medicaid coverage were less likely to get an appointment than patients with private insurance or those without insurance but with the ability to pay for the visit.  Also, there was more difficulty in making the appointment for uninsured patients if they were restricted to paying less than $75 for the visit.

The benefit of the authors’ methods is that the nonresponse bias associated with surveys has been avoided.  One of the limitations of the study is that the appointment process could not be completed in over 11% of the cases, as insurance numbers were needed to complete the process of making the appointment.  The authors however, did not feel that this altered the results significantly.

Click to read the study, published today in JAMA Internal Medicine

Click to read an accompanying editorial in JAMA Internal Medicine

Relevant Reading: Seven Million Americans Live In Areas Where Demand For Primary Care May Exceed Supply By More Than 10 Percent

In-Depth [simulated patient study]:  In this simulated patient study (Audit), between November 2012 and April 2013, over 12,000 calls were made by trained field staff to 7788 primary care practices in 10 states (Arkansas, Georgia, Illinois, Iowa, Massachusetts, Montana, New Jersey, Oregon, Pennsylvania, and Texas). General internal medicine, family medicine, and general practice physicians were identified from the SK&A commercial database. Eligible offices were those that provided outpatient primary care to nonelderly adults from the general population. 84.7% of privately insured patients were able to get an appointment, while only 57.9% of Medicaid patients were able to receive one.  78.8% of uninsured patients willing to make a full cash payment were able to make an appointment, but this rate dropped to 15.4% if the payment had to be restricted to below $75 for the visit.  Wait times did not change significantly based on the type of insurance, and the median wait times across all states ranged between 5-8 days, except in Massachusetts where wait times were closer to 2 weeks.

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