CHICAGO – In a study in which researchers posing as mothers attempted to schedule appointments for sick children at specialty clinics, practices affiliated with academic medical centers were less likely to deny appointments to children with Medicaid-CHIP insurance coverage versus children with commercial insurance, according to report from the Perelman School of Medicine at the University of Pennsylvania published online this week in Archives of Pediatrics & Adolescent Medicine, one of the JAMA/Archives journals.
“Compared with specialty clinics that were not affiliated with an academic medical center, clinics with AMC-affiliated health care providers were more likely to give children with Medicaid-CHIP an opportunity to see a specialist,” the authors write. “However, while they are less likely to outright deny an appointment, academically affiliated clinics were more likely to schedule children with public insurance with longer wait times than privately insured children. Research and oversight that measures and monitors outcomes related to health care access disparities, along with other quality measures, is needed as we make adjustments to our health care delivery systems.”
The study builds on research published in the New England Journal of Medicine in June by the same Penn team showing that specialty physicians, in general, turned away children with Medicaid or Children's Health Insurance Program (CHIP) insurance two thirds of the time.
Using audit study data from 273 specialty clinics in Illinois collected from January through May 2010, the Penn investigators, led by senior author Karin V. Rhodes, MD, MS, director of Emergency Care Policy Research in Penn's department of Emergency Medicine and a senior fellow in the Leonard Davis Institute of Health Economics, examined the association between a clinics’ academic medical center (AMC) affiliation and equity in scheduling appointments for children with public and private insurance. Trained research assistants posing as mothers of children called each clinic twice, and used standard scripts to attempt to schedule appointments for children, in which only the insurance status of the child was modified (Medicaid-CHIP vs. Blue Cross Blue Shield).
Of the 273 paired calls to clinics, 47 percent of academic-affiliated clinics appeared to deny appointments based on insurance status, compared to 67 percent of non-academically-affiliated clinics. Additionally, as the poverty level in the specialty clinics’ neighborhood increased, the likelihood of being denied an appointment based on Medicaid-CHIP status decreased. When assessing wait times, however, the appointments offered by academic clinics to Medicaid-CHIP children had an average wait time of 40 days longer than for children with private insurance. The authors suggest that academic medical centers’ propensity toward serving publicly-insured patients makes them candidates for targeted programs to further boost care for these children, perhaps through financial incentives contingent on equitable appointment acceptance and wait-times.
To read the full press release, visit www.jamamedia.org.