Penn study finds doctors delaying or rejecting specialty care for publicly insured children

A University of Pennsylvania study in which callers posed as mothers seeking pediatric specialty care found that two-thirds of publicly insured children were refused a doctor's appointment, compared with only 11 percent of privately insured children.

Even the low-income children who were not rejected had to wait an average of 42 days for appointments for urgent conditions such as diabetes, seizures, asthma, or a bone fracture - 22 days longer on average than children with private insurance.

"I was disturbed to find this level of disparity," said senior author Karin V. Rhodes, a Penn emergency-medicine physician and health-policy researcher.

The study was commissioned by state officials in Illinois and conducted in the Chicago area. But the authors and other experts say it adds to evidence that the 37 million children covered by Medicaid and the Children's Health Insurance Program (CHIP) too often face discrimination from providers.

The study also has implications for the Affordable Care Act, the federal law that aims to expand coverage to 32 million uninsured people by 2014. Half are expected to be covered by Medicaid.

Policies and incentives "that encourage providers to accept patients with public insurance are needed to improve access to care," Rhodes and Joanna Bisgaier wrote in Thursday's New England Journal of Medicine.

Some barriers to access, such as reimbursement rates, are well-known. In Illinois, the authors noted, an office visit for a moderately severe problem is reimbursed $99.86 by Medicaid-CHIP, compared with $160 by a commercial health plan.

Low-income patients also have more problems with transportation, communication, and day care.

"They may be seen as noncompliant, or more likely to cancel or not show for an appointment," said Ann Bacharach, special projects director at the Pennsylvania Health Law Project, an advocacy organization. "But they lead more chaotic lives. It's hard to take four kids on two buses to get one child to a doctor. And it's a matter of priorities: Do I keep my child's well-child visit, or pay the electric bill?"