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New Study: Medicaid/CHIP Patients Wait Longer for Specialists

A new study authored by the University of Pennsylvania has been released, chronicling the difficulties that children covered by Medicaid or Children’s Health Insurance Program (CHIP) plans have getting to see a specialist—if they can get to see one at all. Currently, the wait to see a specialist under private health insurance is 50% shorter than the waiting period endured by children who have public assistance plans.

Dr. Karin Rhodes, the co-author of the study, said that before the study had been performed she knew the issue was a problem, but had no idea of the actual scale. The study was released in the June 16th edition of the New England Journal of Medicine, and was performed at several hundred Illinois healthy specialty clinics.

Dr. Rhodes said the study reflects the incontrovertible evidence that public and private health insurance is intrinsically different in terms of quality and accessibility of care, especially specialized care. It isn’t limited to one area, it spans the entire public system.

Current federal law requires that recipients of Medicaid or CHIP coverage (who are, largely, low-income children and pregnant women) get the same level and access to medical treatment as those who pay for private insurance—but this does not happen in reality.

In the UP study, female callers, who were posing as the mothers of kids with chronic, serious conditions such as diabetes and seizures, contacted more than 270 medical specialty clinics from January to May of 2010. During the call, the women requested an appointment, and stated that they had private insurance coverage. Other times, another woman would call with the same kind of request but state she had Medicaid or CHIP coverage. What the study showed was that 11% of those who stated they had private insurance were denied an appointment; comparatively, 66% of the callers who stated that they had public insurance were denied.

The clinics that did agree to accept Medicaid or CHIP, the average wait time to get an appointment was 20 days more than the waiting period for private insurance. Private insurance had an average wait time of 20 days, opposed to public insurance waiting for 22 days.

When the callers repeated this procedure with other types of specialty clinics, such as in the fields of orthopedics, asthma, neurology, otolaryngology, psychiatry, and endocrinology, the same trend was repeated.

The study’s authors chose very similar conditions for the study, such as diabetes and seizure disorders, because of their potential long-term impact on children’s health, as well as their common occurrence. Evidence shows that specialty intervention in these conditions at an early age can make a big difference for the patient’s long-term health outcome. One caller documented her experience when she called regarding a child with type 1 diabetes. The wait she was given for an appointment was longer than a year in advance. Dr. Rhodes states that having to wait three weeks in the case of a child who had recently been diagnosed with seizure disorders, diabetes, asthma or a fracture is extremely harmful and not an acceptable standard of care.

When you add an additional 22 days of waiting for the case of a child covered by public insurance, this amounts to discrimination based solely on insurance, which is illegal. Dr. Rhodes suggests that each state must begin polling tis own clinics, especially those states thinking about cutting funding for Medicaid and CHIP.

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