Author Topic: Accessible medical care for all in the US? Think again  (Read 78 times)

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Offline agate

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Accessible medical care for all in the US? Think again
« on: April 08, 2014, 08:40:50 am »
According to a survey discussed in a MedPage Today blog entry(April 7, 2014), it is difficult for someone unable to pay $75 or more in cash to get an appointment with a medical provider if there's no insurance. It also seems to be harder for persons on Medicaid to get appointments with medical providers than it is for people with private insurance.


Quote
Prime Time: When Docs Require Cash on Delivery

By Sarah Wickline, Staff Writer, MedPage Today

When a team of medical "mystery shoppers" tried to get primary care office visits as new patients, they discovered that they needed private insurance coverage or had to be willing to pay at least $75 in cash upfront -- or the majority of providers wouldn't see them.

Karin V. Rhodes, MD, MS, of the Center for Emergency Care Policy & Research at the University of Pennsylvania, and colleagues, assessed new patient access to primary care providers in our shifting healthcare landscape.

Their study, published today in JAMA Internal Medicine, asked a couple of important questions about insurance coverage and access to healthcare in the U.S.

The first: How financially flexible are primary care providers? It's a fundamental component of our social structure to receive compensation for time and/or services. However, in healthcare, where exactly providers draw that compensation line can mean the difference between undiagnosed/untreated medical conditions and managed care.

Second: Are primary care providers ready to take on more Medicaid patients? Just because more people have coverage doesn't mean providers will be able to manage the influx. How will the theories that backed expansion policies play out in the field?

The authors trained a group of 10 people to call primary care practices and seek appointments as new patients from November 2012 to April 2013. Each caller pretended to have private insurance, Medicaid, or no insurance, and to need an appointment for either a "routine" visit or "a very high blood pressure reading."

Overall, 12,907 calls were made to 7,788 primary care practices, resulting in 84.7% of privately insured callers (95% CI 82.6%-86.8%), and 57.9% of Medicaid callers (95% CI 54.8%-61.0%) being able to get an appointment within 1 week (2 weeks for Massachusetts). No surprise, right?

Here's the kicker: When callers identified themselves as uninsured, but willing to pay cash, 78.8% were able to set an appointment if they were able to make a payment over $75 at the time of the visit. If the payment at the time of the visit was likely to be less than $75, only 15.4% of callers were able to secure an appointment (95% CI 13.2%-17.6%).

...

Rhodes and colleagues found that only one-fifth of the practices allowed for a flexible payment schedule for uninsured patients. The median cost for the appointment varied by state from $120-$150.

...

The findings provide baseline data for future comparisons between pre-and post-ACA America, according to the authors.

One oddity worth noting is the number of unreachable offices in this study. Despite five separate attempts, all at different times of day and days of the week, 536 providers' offices could not be reached. I hope their existing patients didn't hit the same wall.

_______

Prime Time is a blog by staff writer, Sarah Wickline, for readers with an interest in primary care.

The research was supported by the Robert Wood Johnson Foundation. One co-author reported funding from Robert Wood Johnson Foundation Health and Society Scholars Program.

Blue Cross Blue Shield Foundation of Massachusetts supported the Massachusetts supplemental sample.

The blog article in its entirety is available here.
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SPMS, diagnosed 1980. Avonex 2001-2004. Copaxone 2007-2010. Glatopa (glatiramer acetate 40mg 3 times/week) since 12/16/20.