Determining proper payment for healthcare services is a fascinating problem of substantial complexity, and, with the “Affordable Care Act” and various past and future movements towards public insurance, there is a great deal of uncertainty regarding physician payment – both in the amount (public vs. private insurance) or whether (uncompensated care in hospitals, emergency departments).
This is a very interesting study out of NEJM that is applicable to the 70 to 80% of emergency departments we send home with instructions to “follow-up with X”. They nicely demonstrate that, in Chicago, at least, “follow-up with X” is nearly trivially easy with private insurance, and much more difficult if funded by one of their Medicaid providers for children. Excepting child psychiatry – which is in shortage – when calling a specialist for follow-up claiming to have private insurance, their research assistants could schedule an appointment well over 90% of the time. Alternatively, when stating they had public insurance for their child, ability to follow-up ranged from 20 to 57%, depending on the specialty.
Not only that, public insurance patients waited a mean of 42 days for their appointment versus 22 days for private insurance, when they looked at clinics that would even accept that insurance option.
And, the clinical scenarios they presented for follow-up were not just routine new patient appointments – they were pediatric patients with legitimate uncontrolled morbid disease with the potential to significantly worsen and impact their overall health.
I don’t have a solution to a complex social, financial, and political problem with complex social, financial, and political obstacles – but the more good articles like this are published, the more likely smart folks will start working on solutions.
“Auditing access to specialty care for children with public insurance.”
http://www.ncbi.nlm.nih.gov/pubmed/21675891