NCPA - National Center for Policy Analysis

Health Insurance Doesn't Mean Access to Health Care

June 17, 2011

Expansions of Medicaid and the Children's Health Insurance Program (CHIP) are designed to extend access to high-quality medical care to all U.S. children.  However, evidence suggests that the 37 million children covered by Medicaid-CHIP are less likely to receive specialty care than children covered by commercial insurance, say Joanna Bisgaier, M.S.W., and Karin V. Rhodes, M.D.

  • Children covered by Medicaid-CHIP may face greater barriers to specialist care as a result of fewer resources within their families, including lower levels of income, education, language proficiency and health literacy.
  • Another possible explanation for disparities is that specialists choose not to accept public insurance.

With the use of an experimental study design involving simulated requests for specialty care, Bisgaier and Rhodes measured real-world scheduling behavior in an urban area with a high density of medical specialists. 

  • The results showed significant disparities in children's access to needed outpatient specialty care, attributable to specialists' reluctance to accept public health insurance; these results held across all audited specialties.
  • Moreover, even when children with Medicaid-CHIP were not denied appointments outright, the appointments were, on average, 22 days later than those obtained for privately insured children with identical health conditions.
  • Notably, even callers claiming to have a privately insured child faced an average wait time of 20 days when urgently requesting an appointment.

These findings signal a need to consider refining specialty care delivery processes to more efficiently use the specialist workforce, say Bisgaier and Rhodes.

Source: Joanna Bisgaier and Karin V. Rhodes, "Auditing Access to Specialty Care for Children with Public Insurance," New England Journal of Medicine, June 15, 2011.

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