April 7, 2014 / 8:25 PM / in 4 years

Doctor appointment availability varies by insurance type

NEW YORK (Reuters Health) - People’s chances of getting a new primary care doctor vary depending on their insurance, according to a new study.

Researchers calling doctors’ offices and claiming to be a patient with private insurance had about an 85 percent success rate for getting appointments. Their success rate was about 58 percent when they claimed to have Medicaid, the government insurance for the poor.

The high success rates for getting an appointment may bode well for the millions of Americans who recently gained insurance through the 2010 Affordable Care Act (ACA), commonly referred to as Obamacare.

“Establishing a relationship with a primary care provider is a pretty important step in realizing the benefits of healthcare,” Dr. Karin Rhodes said. “We wanted to know if there was enough primary care capacity in the system to allow for the new enrollees coming in.”

Rhodes is the study’s lead author from the Perelman School of Medicine at the University of Pennsylvania in Philadelphia.

She and her colleagues write in JAMA Internal Medicine that it was not known at the time of the ACA’s passage whether the primary care system could accommodate the newly insured.

“Given that access to primary care is considered a prerequisite for improved population health outcomes, a strained primary care system may place many of the goals of the ACA at risk,” they write.

The possibility of not getting into a doctor’s patient log may be especially concerning for people who gain insurance through Medicaid, which typically has some of the lowest reimbursement rates for doctors.

For the new study, the researchers called doctors’ offices in 10 U.S. states to ask about making an appointment as a new patient. The team made about 13,000 calls to almost 8,000 doctors’ offices between November 2012 and April 2013.

About 85 percent of people who said they had private insurance were able to make appointments. About 58 percent of people claiming to have Medicaid were also successful.

Typically, those people had to wait about a week for their appointments. Three quarters were offered an appointment within two weeks.

As for the uninsured, about 79 percent of people who said they were not covered but were willing to pay cash got appointments. But only 15 percent of uninsured patients were offered a payment option that involved them paying $75 or less upfront.

“I think a lot of times Medicaid is criticized as being bad insurance, but we found that Medicaid provides a lot more access than being a low-income, uninsured person,” Rhodes said.

She said the study shows capacity exists and it will be important to show people shopping for insurance which plans have doctors accepting new patients.

Dr. Andrew Bindman, who co-wrote an editorial accompanying the new study, said the lower success rate among Medicaid patients in getting a new appointment may warrant more analysis, however.

“This study suggests that even before this expansion that Medicaid beneficiaries’ options may be limited,” he said. “The addition of so many new enrollees into this program could put additional stress on a pool of physicians who were already stretched to meet the needs of Medicaid beneficiaries prior to this expansion.”

Bindman is from the Philip R. Lee Institute for Health Policy Studies at the University of California, San Francisco.

“Policymakers who have oversight and management responsibilities for the Medicaid program should establish a valid and reliable method for monitoring access to care for Medicaid beneficiaries,” he said in an email to Reuters Health.

Rhodes said she and her colleagues conducted the study to see what access was like before the ACA implementation.

“We will track it going forward,” she said.

SOURCE: bit.ly/MbBLb9 JAMA Internal Medicine, online April 7, 2014.

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