BOSTON (Reuters Health) - Sick children covered by Medicaid or the Children's Health Insurance Program (CHIP) must wait twice as long as youngsters with private insurance to get an appointment with a specialist -- if they can get an appointment at all, according to a new study of a few hundred specialty clinics in Illinois.
Although past research has shown a disparity in care between people covered by public and private health insurance, this is the first to take a comprehensive look at specialty care in children, said coauthor Dr. Karin Rhodes of the University of Pennsylvania.
"We had an idea that this was a problem, but we didn't know the magnitude of it," she told Reuters Health.
The study, in the June 16 New England Journal of Medicine, "is clear and convincing evidence" that children with public insurance are treated differently, she said, "and it's across the system."
Federal law says that Medicaid recipients must have the same access to care as the general population.
During the first five months of 2010, female callers posed as mothers whose child needed specialty care for serious conditions such as severe depression, diabetes and seizures. They tried to get appointments at 273 specialty clinics in Cook County, Illinois. At one point they said they had private insurance; at another, they offered an identical scenario but said the child had Medicaid and CHIP coverage.
While care was denied in only 11% of the clinics when private insurance coverage was offered, the denial rate was 66% when the clinic was told the child was covered by public insurance.
And in the case where Medicaid-CHIP insurance was accepted, those children were told that they would have to wait, on average, 22 days longer than those covered by private insurance.
The typical wait for an appointment was 20 days in the private coverage group and 42 days for Medicaid-CHIP.
The trend was seen across all seven specialties tested -- orthopedics, psychiatry, asthma, neurology, endocrinology, otolaryngology and dermatology.
Rhodes and coauthor Joanna Bisgaier, also of the University of Pennsylvania, selected conditions "that were very common and where there's evidence that specialty intervention can make a difference in long-term outcomes," Rhodes said.
One woman who called seeking treatment for a child's newly-diagnosed type 1 diabetes was told that the wait would be one year.
Even for the children with private insurance who could get an appointment, on average, after 20 days, "just having to wait three weeks with a kid with a new onset seizure, or diabetes, or poorly-controlled asthma, or a fracture is disturbing in itself," Rhodes said.
"You add an extra 22 days on to that, and what you've got is disparities, discrimination that is purely based on insurance."
One solution, she said, may be to realign the financial incentives in specialty care and allocate specialty care more wisely.
She said other states should consider doing a similar test, particularly if they are thinking of scaling back public insurance programs to save money.
"Every state should be studying their access, particularly if they're considering cuts to Medicaid because they're cash-strapped and they think they're going to take it out of their healthcare budget," she said. "If we keep whittling away at these programs, we will increase the disparities."
SOURCE: bit.ly/iYmooO N Engl J Med June 15, 2011.