In a study, individuals posing as patients covered by private insurance were more likely to secure a primary care appointment as a new patient compared with individuals posing as patients who either were covered by Medicaid or uninsured.
The Affordable Care Act expands insurance access in an effort to improve access to care for the newly uninsured, but whether the primary care system can handle the increased demand is unknown, according to the study, which was published April 7 on the website of JAMA Internal Medicine.
Karin V. Rhodes, MD, MS, of the University of Pennsylvania’s Perelman School of Medicine, Philadelphia, and colleagues sought to estimate a baseline for primary care access before the ACA coverage expansions took effect in January.
Trained field staff called primary care offices in Arkansas, Georgia, Illinois, Iowa, Massachusetts, Montana, New Jersey, Oregon, Pennsylvania and Texas to ask about making a new patient appointment between November 2012 and April 2013. The callers posed as nonelderly adults with either private insurance, Medicaid or no insurance. A total of 12,907 calls were made to 7,788 primary care practices.
Across the 10 states, 84.7% of the callers who said they had private insurance were able to get an appointment, as were 57.9% of callers claiming to have Medicaid coverage. We expect that the search issues currently faced by Medicaid patients will also be relevant for patients who are newly insured through the health insurance exchanges, particularly if they select lower-cost plans with more constricted provider networks, the authors wrote.
Appointment rates were 78.8% for uninsured patients offering full cash payment, but only 15.4% if the payment required at the time of the visit was $75 or less. Our findings have important implications for the uninsured, the authors wrote, particularly in states that are choosing not to expand Medicaid. Given that more than two-thirds of the uninsured in these 10 states have incomes below 200% of the federal poverty level, our finding that only 15% of the uninsured could obtain an appointment for $75 or less at the time of the visit suggests that access will continue to be problematic for this population.
Median wait times ranged from between five and eight days for private and Medicaid callers. About 75% of callers in both those patient groups were able to get a new-patient appointment in fewer than two weeks.
As the largest insurance expansion in two generations unfolds, it will be important to track the effect on access to care for newly and currently insured patients and the costs for those who remain uninsured or select high-deductible plans, the authors concluded.