Insurance Status Determines Access to Follow-Up Care, Study Finds
Patients who have private health insurance are more likely to receive follow-up care within one week of emergency department treatment than those who are enrolled in Medicaid or lack health coverage, according to a study published on Wednesday in the Journal of the American Medical Association, the AP/Las Vegas Sun reports. For the study -- led by Brent Asplin, head of emergency medicine at Minnesota-based Regions Hospital -- researchers had graduate students pose as patients treated in EDs for pneumonia, high blood pressure or suspected tubal pregnancies. The students later called clinics and said that they had received ED treatment the previous night and were instructed to receive follow-up care as early as possible. Each student posed both as a patient who had private health insurance and as a patient who was enrolled in Medicaid or lacked health coverage (Tanner, AP/Las Vegas Sun, 9/13).
The study involved 499 unidentified clinics (Lerner, Minneapolis Star Tribune, 9/14). The clinics involved in the study were located in Atlanta; Chicago; Dallas-Fort Worth; Denver; Jacksonville, Fla.; Los Angeles; Minneapolis-St. Paul; New York City; and Phoenix (AP/Las Vegas Sun, 9/13). According to the study, students who posed as patients who had private health insurance received appointments from clinics 64% of the time, compared with 34% for those who posed as patients enrolled in Medicaid. Students who posed as patients who lacked health insurance and had less than $20 in cash received appointments from clinics 25% of the time, the study found.
However, the study found that students who posed as patients who lacked health insurance and offered to pay in full received appointments from clinics 63% of the time (Minneapolis Star Tribune, 9/14). Overall, only 28% of clinics sought to determine how sick the students were, but 98% asked about their health insurance status, the study found (AP/Las Vegas Sun, 9/13).
"The bottom line from the study is that health insurance matters, and dollars are continuing to drive access to care in our health care system," Asplin said, adding, "Despite how serious these conditions were, callers still had problems getting an appointment when they didn't have the proper insurance card." He said, "We certainly should not act like we're powerless to change it. We need a whole new discussion about health insurance in America" (Minneapolis Star Tribune, 9/14).
Carmela Coyle, senior vice president for policy at the American Hospital Association, called the results of the study "a disgrace." She added, "As a nation, we've got to find a way to provide coverage for everybody, not just those who are employed" or can afford to pay for private health insurance.
Lisa Gregory of the Illinois Primary Health Care Association in part attributed the study results to previous data that indicate patients who are enrolled in Medicaid or lack health insurance are less likely to keep appointments at clinics as those who have private health coverage (AP/Las Vegas Sun, 9/13). An abstract of the study is available online.