Auditing Access to Specialty Care for Children with Public Insurance

TLDR

Health care reform expanded public insurance eligibility but left access concerns unresolved. The study measured children’s access to outpatient specialty care to detect disparities between Medicaid‑CHIP and private insurance. Researchers conducted paired telephone calls to a stratified random sample of 273 specialty clinics, posing as mothers with common pediatric conditions and using a standardized script that varied by insurance status. The study found that 66% of Medicaid‑CHIP callers were denied appointments versus 11% of private‑insurance callers, with Medicaid‑CHIP patients experiencing an average 22‑day longer wait, indicating significant access disparities that warrant policy interventions to increase provider acceptance of public insurance.

Abstract

Health care reform has expanded eligibility to public insurance without fully addressing concerns about access. We measured children's access to outpatient specialty care to identify disparities in providers' acceptance of Medicaid and the Children's Health Insurance Program (CHIP) versus private insurance.Between January and May 2010, research assistants called a stratified, random sample of clinics representing eight specialties in Cook County, Illinois, which has a high proportion of specialists. Callers posed as mothers of pediatric patients with common health conditions requiring outpatient specialty care. Two calls, separated by 1 month, were placed to each clinic by the same person with the use of a standardized clinical script that differed by insurance status.We completed 546 paired calls to 273 specialty clinics and found significant disparities in provider acceptance of Medicaid-CHIP versus private insurance across all tested specialties. Overall, 66% of Medicaid-CHIP callers (179 of 273) were denied an appointment as compared with 11% of privately insured callers (29 of 273) (relative risk, 6.2; 95% confidence interval [CI], 4.3 to 8.8; P<0.001). Among 89 clinics that accepted both insurance types, the average wait time for Medicaid-CHIP enrollees was 22 days longer than that for privately insured children (95% CI, 6.8 to 37.5; P=0.005).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.