It has been documented that children insured by Medicaid in California have significantly less access to orthopaedic care than children with private insurance. We imagine that, since Medicaid reimburses doctors below the overhead cost of for an office visit, doctors are less likely to want to see Medicaid patients. The first objective of this study is to examine whether children insured by Medicaid have limited access to orthopedic care in a national sample. The second objective is to determine whether Medicaid physician reimbursement rates may play a role in limiting children's access to orthopedic care.
Methods:
One hundred and fifty orthopedic surgeon's offices, 3 randomly chosen in each of 50 states, were telephoned with a request for an appointment to see a 10 year old with a fractured arm. Each office was called twice with an identical script except for insurance status: once with Medicaid and once with private insurance. Each state sets its own rate of physician reimbursement, and we were able to find these rates.
Results:
All of the children with private insurance were offered an appointment with all 150 surveyed practices, compared to only 48% of children with Medicaid. The relationship between reimbursement rates for outpatient consultation and an appointment being offered to a patient with Medicaid was statistically significant.
Conclusion:
Children insured with Medicaid have significantly less access to orthopedic care in this nation-wide sample than children with private insurance. Medicaid physician reimbursement for an outpatient does have a big effect on the willingness of doctors to see these patients. These findings suggest that Medicaid programs are in violation of federal law requiring physician payments be high enough so that services to Medicaid recipients are available to the same extent as those available to the general population.
Introduction: