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Rankin KA, Mosier-Mills A, Hsiang W, Wiznia DH. Secret shopper studies: an unorthodox design that measures inequities in healthcare access. Arch Public Health 2022; 80:226. [PMID: 36329541 PMCID: PMC9635177 DOI: 10.1186/s13690-022-00979-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 10/05/2022] [Accepted: 10/13/2022] [Indexed: 11/06/2022] Open
Abstract
Secret shopper studies are particularly potent study designs that allow for the gathering of objective data for a variety of research hypotheses, including but not limited to, healthcare delivery, equity of healthcare, and potential barriers to care. Of particular interest during the COVID-19 pandemic, secret shopper study designs allow for the gathering of data over the phone. However, there is a dearth of literature available on appropriate methodological practices for these types of studies. To make these study designs more widely accessible, here we outline the case for using the secret shopper methodology and detail best practices for designing and implementing them.
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Affiliation(s)
- Kelsey A Rankin
- Yale School of Medicine, 333 Cedar Street, 06510, New Haven, CT, USA.
| | | | - Walter Hsiang
- Yale School of Medicine, 333 Cedar Street, 06510, New Haven, CT, USA
| | - Daniel H Wiznia
- Yale School of Medicine, 333 Cedar Street, 06510, New Haven, CT, USA
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Hsiang WR, Lukasiewicz A, Gentry M, Kim CY, Leslie MP, Pelker R, Forman HP, Wiznia DH. Medicaid Patients Have Greater Difficulty Scheduling Health Care Appointments Compared With Private Insurance Patients: A Meta-Analysis. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2019; 56:46958019838118. [PMID: 30947608 PMCID: PMC6452575 DOI: 10.1177/0046958019838118] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Medicaid patients are known to have reduced access to care compared with privately insured patients; however, quantifying this disparity with large controlled studies remains a challenge. This meta-analysis evaluates the disparity in health services accessibility of appointments between Medicaid and privately insured patients through audit studies of health care appointments and schedules. Audit studies evaluating different types of outpatient physician practices were selected. Studies were categorized based on the characteristics of the simulated patient scenario. The relative risk of appointment availability was calculated for all different types of audit scenario characteristics. As a secondary analysis, appointment availability was compared pre- versus post-Medicaid expansion. Overall, 34 audit studies were identified, which demonstrated that Medicaid insurance is associated with a 1.6-fold lower likelihood in successfully scheduling a primary care appointment and a 3.3-fold lower likelihood in successfully scheduling a specialty appointment when compared with private insurance. In this first meta-analysis comparing appointment availability between Medicaid and privately insured patients, we demonstrate Medicaid patients have greater difficulty obtaining appointments compared with privately insured patients across a variety of medical scenarios.
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Affiliation(s)
| | | | - Mark Gentry
- 1 Yale School of Medicine, New Haven, CT, USA
| | - Chang-Yeon Kim
- 2 University Hospitals Cleveland Medical Center, OH, USA
| | | | | | - Howard P Forman
- 1 Yale School of Medicine, New Haven, CT, USA.,3 Yale School of Public Health, New Haven, CT, USA
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Disparities in Pediatric Provider Availability by Insurance Type After the ACA in California. Acad Pediatr 2019; 19:325-332. [PMID: 30218840 DOI: 10.1016/j.acap.2018.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 08/20/2018] [Accepted: 09/08/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To examine insurance-based disparities in provider-related barriers to care among children in California in the wake of changes to the insurance market resulting from the Affordable Care Act. METHODS Our sample included 6514 children (ages 0 to 11 years) from the 2014-2016 California Health Interview Survey. We examined parent reports in the past year of 1) having trouble finding a general provider for the child, 2) the child not being accepted by a provider as a new patient, 3) the child's health insurance not being accepted by a provider, or 4) any of the above. Multivariable models estimated the associations of insurance type-Medi-Cal (Medicaid), employer-sponsored insurance, or privately purchased coverage-and parent reports of these problems. RESULTS Approximately 8% of parents had encountered at least one of these problems. Compared with parents of children with employer-sponsored insurance, parents of children with Medi-Cal or privately purchased coverage had over twice the odds of experiencing at least one of the barriers. Parents of children with Medi-Cal had over twice the odds of being told a provider would not accept their children's coverage or having trouble finding a general provider and 3times the odds of being told a provider would not accept their children as new patients. Parents of children with privately purchased coverage had over 3times the odds of being told a provider would not accept their children's coverage. CONCLUSIONS Our study found significant disparities in provider-related barriers by insurance type among children in California.
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Oostrom T, Einav L, Finkelstein A. Outpatient Office Wait Times And Quality Of Care For Medicaid Patients. Health Aff (Millwood) 2018; 36:826-832. [PMID: 28461348 DOI: 10.1377/hlthaff.2016.1478] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The time patients spend in a doctor's waiting room prior to a scheduled appointment is an important component of the quality of the overall health care experience. We analyzed data on twenty-one million outpatient visits obtained from electronic health record systems, which allowed us to measure time spent in the waiting room beyond the scheduled appointment time. Median wait time was a little more than four minutes. Almost one-fifth of visits had waits longer than twenty minutes, and 10 percent were more than thirty minutes. Waits were shorter for early-morning appointments, for younger patients, and at larger practices. Median wait time was 4.1 minutes for privately insured patients and 4.6 minutes for Medicaid patients. After adjustment for patient and appointment characteristics, Medicaid patients were 20 percent more likely than the privately insured patients to wait longer than twenty minutes, with most of this disparity explained by differences in practices and providers they saw. Wait times for Medicaid patients relative to privately insured patients were longer in states with relatively lower Medicaid reimbursement rates. The study complements other work that suggests that Medicaid patients face some additional barriers in the receipt of care.
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Affiliation(s)
- Tamar Oostrom
- Tamar Oostrom is a doctoral student in the Department of Economics at the Massachusetts Institute of Technology, in Cambridge
| | - Liran Einav
- Liran Einav is a professor in the Department of Economics at Stanford University, in California
| | - Amy Finkelstein
- Amy Finkelstein is the John & Jennie S. MacDonald Professor of Economics in the Department of Economics, Massachusetts Institute of Technology
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Tipirneni R, Rhodes KV, Hayward RA, Lichtenstein RL, Reamer EN, Davis MM. Primary care appointment availability for new Medicaid patients increased after Medicaid expansion in Michigan. Health Aff (Millwood) 2017. [PMID: 26202057 DOI: 10.1377/hlthaff.2014.1425] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Affordable Care Act expands health insurance coverage to millions of Americans, but the availability of health care services for the newly insured population remains uncertain. We conducted a simulated patient (or "secret shopper") study to assess primary care appointment availability and wait times for new patients with Medicaid or private insurance before and after implementation of Michigan's Medicaid expansion in 2014. The expansion, which was made possible through a section 1115 waiver, has a unique requirement that new beneficiaries must be seen by a primary care provider within 60-90 days of enrollment. During a period of rapid coverage expansion in Michigan, we found that appointment availability increased 6 percentage points for new Medicaid patients and decreased 2 percentage points for new privately insured patients, compared to availability before the expansion. Wait times remained stable, at 1-2 weeks for both groups. Further research is needed to determine whether access to primary care for newly insured patients will endure over time.
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Affiliation(s)
- Renuka Tipirneni
- Renuka Tipirneni is a Robert Wood Johnson Foundation Clinical Scholar and clinical lecturer in the Department of Internal Medicine at the Medical School and a member of the Institute for Healthcare Policy and Innovation, both at the University of Michigan, in Ann Arbor
| | - Karin V Rhodes
- Karin V. Rhodes is an associate professor of emergency medicine and director of the Center for Emergency Care Policy and Research at the Perelman School of Medicine, University of Pennsylvania, in Philadelphia
| | - Rodney A Hayward
- Rodney A. Hayward is a professor of internal medicine and public health and a member of the Institute for Healthcare Policy and Innovation at the University of Michigan and a senior research scientist at the Veterans Affairs Center for Clinical Management Research, both in Ann Arbor
| | - Richard L Lichtenstein
- Richard L. Lichtenstein is the S. J. Axelrod Collegiate Professor of Health Management and Policy at the School of Public Health and a member of the Institute for Healthcare Policy and Innovation, both at the University of Michigan
| | - Elyse N Reamer
- Elyse N. Reamer is a research assistant at the Robert Wood Johnson Foundation Clinical Scholars Program in the Medical School at the University of Michigan
| | - Matthew M Davis
- Matthew M. Davis is a professor of pediatrics, internal medicine, and public policy and deputy director of the Institute for Healthcare Policy and Innovation at the University of Michigan
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Wisk LE, Finkelstein JA, Sawicki GS, Lakoma M, Toomey SL, Schuster MA, Galbraith AA. Predictors of timing of transfer from pediatric- to adult-focused primary care. JAMA Pediatr 2015; 169:e150951. [PMID: 26030515 PMCID: PMC4862601 DOI: 10.1001/jamapediatrics.2015.0951] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE A timely, well-coordinated transfer from pediatric- to adult-focused primary care is an important component of high-quality health care, especially for youths with chronic health conditions. Current recommendations suggest that primary-care transfers for youths occur between 18 and 21 years of age. However, the current epidemiology of transfer timing is unknown. OBJECTIVE To examine the timing of transfer to adult-focused primary care providers (PCPs), the time between last pediatric-focused and first adult-focused PCP visits, and the predictors of transfer timing. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study of patients insured by Harvard Pilgrim Health Care (HPHC), a large not-for-profit health plan. Our sample included 60 233 adolescents who were continuously enrolled in HPHC from 16 to at least 18 years of age between January 2000 and December 2012. Pediatric-focused PCPs were identified by the following provider specialty types, but no others: pediatrics, adolescent medicine, or pediatric nurse practitioner. Adult-focused PCPs were identified by having any provider type that sees adult patients. Providers with any specialty provider designation (eg, gastroenterology or gynecology) were not considered PCPs. MAIN OUTCOMES AND MEASURES We used multivariable Cox proportional hazards regression to model age at first adult-focused PCP visit and time from the last pediatric-focused to the first adult-focused PCP visit (gap) for any type of office visit and for those that were preventive visits. RESULTS Younger age at transfer was observed for female youths (hazard ratio [HR], 1.32 [95% CI, 1.29-1.36]) who had complex (HR, 1.06 [95% CI, 1.01-1.11]) or noncomplex (HR, 1.08 [95% CI, 1.05-1.12]) chronic conditions compared with those who had no chronic conditions. Transfer occurred at older ages for youths who lived in lower-income neighborhoods compared with those who lived in higher-income neighborhoods (HR, 0.89 [95% CI, 0.83-0.95]). The gap between last pediatric-focused to first adult-focused PCP visit was shorter for female youths than male youths (HR, 1.57 [95% CI, 1.53-1.61]) and youths with complex (HR, 1.35 [95% CI, 1.28-1.41]) or noncomplex (HR, 1.24 [95% CI, 1.20-1.28]) chronic conditions. The gap was longer for youths living in lower-income neighborhoods than for those living in higher-income neighborhoods (HR, 0.80 [95% CI, 0.75-0.85]). Multivariable models showed an adjusted median age at transfer of 21.8 years for office visits and 23.1 years for preventive visits and an adjusted median gap length of 20.5 months for office visits and 41.6 months for preventive visits. CONCLUSIONS AND RELEVANCE Most youths are transferring care later than recommended and with gaps of more than a year. While youths with chronic conditions have shorter gaps, they may need even shorter transfer intervals to ensure continuous access to care. More work is needed to determine whether youths are experiencing clinically important lapses in care or other negative health effects due to the delayed timing of transfer.
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Affiliation(s)
- Lauren E. Wisk
- Center for Child Health Care Studies, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts2Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital, Boston, Ma
| | - Jonathan A. Finkelstein
- Center for Child Health Care Studies, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts2Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital, Boston, Ma
| | - Gregory S. Sawicki
- Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts3Department of Pediatrics, Harvard Medical School, Boston, Massachusetts4Division of Pulmonary and Respiratory Diseases, Boston Children’s Hospital, B
| | - Matthew Lakoma
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | - Sara L. Toomey
- Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts3Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Mark A. Schuster
- Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital, Boston, Massachusetts3Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Alison A. Galbraith
- Center for Child Health Care Studies, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts2Division of General Pediatrics, Department of Medicine, Boston Children’s Hospital, Boston, Ma
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Dorsey ER, George BP, Leff B, Willis AW. The coming crisis: obtaining care for the growing burden of neurodegenerative conditions. Neurology 2013; 80:1989-96. [PMID: 23616157 DOI: 10.1212/wnl.0b013e318293e2ce] [Citation(s) in RCA: 115] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
As the U.S. population ages, the burden of neurodegenerative disorders, including Alzheimer disease and Parkinson disease, will increase substantially. However, many of these patients and their families currently do not receive neurologic care. For example, a recent study found that over 40% of Medicare beneficiaries with an incident Parkinson disease diagnosis did not receive neurologist care early after diagnosis and those who did not were more likely to fracture a hip, be placed in a nursing home, and die. While geography, age, race, and sex likely contribute to these observed disparities in care and outcomes, a large barrier may be Medicare's reimbursement policies, which value procedures over care. With further reductions in Medicare reimbursement constantly on the horizon, the devaluing of clinical care will likely continue. Rather than guaranteeing access to care, Medicare's reimbursement policies may increasingly be an impediment to care.
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Affiliation(s)
- E Ray Dorsey
- Department of Neurology, Johns Hopkins Medicine, Baltimore, MD, USA.
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Abstract
BACKGROUND Health care reform has expanded eligibility to public insurance without fully addressing concerns about access. We measured children's access to outpatient specialty care to identify disparities in providers' acceptance of Medicaid and the Children's Health Insurance Program (CHIP) versus private insurance. METHODS Between January and May 2010, research assistants called a stratified, random sample of clinics representing eight specialties in Cook County, Illinois, which has a high proportion of specialists. Callers posed as mothers of pediatric patients with common health conditions requiring outpatient specialty care. Two calls, separated by 1 month, were placed to each clinic by the same person with the use of a standardized clinical script that differed by insurance status. RESULTS We completed 546 paired calls to 273 specialty clinics and found significant disparities in provider acceptance of Medicaid-CHIP versus private insurance across all tested specialties. Overall, 66% of Medicaid-CHIP callers (179 of 273) were denied an appointment as compared with 11% of privately insured callers (29 of 273) (relative risk, 6.2; 95% confidence interval [CI], 4.3 to 8.8; P<0.001). Among 89 clinics that accepted both insurance types, the average wait time for Medicaid-CHIP enrollees was 22 days longer than that for privately insured children (95% CI, 6.8 to 37.5; P=0.005). CONCLUSIONS We found a disparity in access to outpatient specialty care between children with public insurance and those with private insurance. Policy interventions that encourage providers to accept patients with public insurance are needed to improve access to care.
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Affiliation(s)
- Joanna Bisgaier
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA 19104, USA
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Bisgaier J, Cutts DB, Edelstein BL, Rhodes KV. Disparities in child access to emergency care for acute oral injury. Pediatrics 2011; 127:e1428-35. [PMID: 21606154 DOI: 10.1542/peds.2011-0011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE We examined the impact of insurance status on dental practices' willingness to schedule an appointment for a child with a symptomatic fractured permanent front tooth. PATIENTS AND METHODS Between February and May 2010, 6 research assistants posed as mothers of a 10-year-old boy seeking an urgent dental appointment. Two calls 4 weeks apart, with the same clinical scenario, were made by the same caller to a stratified random sample of dental practices, one-half of which were enrolled in the state's combined Medicaid and Children's Health Insurance Program (CHIP) dental program. The only difference in the calls was the child's insurance coverage (Medicaid/CHIP versus private Blue Cross dental coverage). We estimated differences in the log-odds probability of scheduling an appointment for a child with public versus private insurance by using exact conditional (fixed-effects) logistic regression, which accounts for paired data. RESULTS Of 170 paired calls to 85 dental practices (41 participating in the Medicaid program), only 36.5% of Medicaid beneficiaries obtained any appointment compared with 95.4% of Blue Cross-insured children with the same oral injury. Among dental providers enrolled in the Medicaid program, children with Medicaid were still 18.2 times more likely to be denied an appointment than privately insured counterparts (95% confidence interval: 3.1 to ∞; P < .001). CONCLUSIONS Illinois dentists, including those participating in Medicaid, are less likely to see a child for an urgent dental complaint if the child has public versus private dental coverage. These results have implications for developing policies that improve access to oral health care.
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Affiliation(s)
- Joanna Bisgaier
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA 19104, USA
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Schuur JD, Shah A, Wu Z, Forman HP, Gross CP. The impact of Medicaid coverage and reimbursement on access to diagnostic mammography. Cancer 2009; 115:5566-78. [PMID: 19728371 PMCID: PMC3723693 DOI: 10.1002/cncr.24637] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Women of low socioeconomic status are at risk for delayed evaluation of abnormal mammograms and later stage presentations of breast cancer. Medicaid reimbursement for clinical services is lower than Medicare reimbursement, yet it is unclear whether low Medicaid reimbursement is a barrier to accessing mammography. The objective of the current study was to determine the association between reported insurance type (Medicaid vs Medicare), Medicaid reimbursement rate, and access to diagnostic mammography (DM). METHODS Standardized patients (SPs) called 521 mammography facilities in defined geographic regions of 11 states in 2005. Facilities were divided between high, middle, and low reimbursing states based on the state's relative Medicaid-to-Medicare reimbursement rate for DM. SPs contacted each facility twice to schedule a DM using the same clinical vignette but switching insurance status (Medicaid vs Medicare). The authors measured the proportion of SPs who were offered 1) any appointment and 2) a timely appointment, defined as a third available appointment within 20 business days. RESULTS SPs with Medicaid were less likely to receive an appointment than SPs with Medicare (91% vs 99.1%; difference, 8.1%; 95% confidence interval, 5.3%-10.9% [P < .001]). Among facilities that offered appointments to both callers, the proportion of timely appointments did not differ between Medicaid (93.7%) and Medicare (92.9%; P = .51). States' Medicaid reimbursement rates for DM were not associated with the percentage of SPs with Medicaid who were offered any appointment (P = .50) or a timely appointment (P = .69). CONCLUSIONS Callers with Medicaid were offered appointments for DM less frequently than callers with Medicare, although both were widely accepted. State Medicaid reimbursement rates did not affect access to mammography.
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Affiliation(s)
- Jeremiah D Schuur
- Robert Wood Johnson Clinical Scholars Program, Veterans Affairs Medical Center, West Haven, Connecticut, USA.
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Kuo SC, Chen YS, Lin KC, Lee TY, Hsu CH. Evaluating the effects of an Internet education programme on newborn care in Taiwan. J Clin Nurs 2009; 18:1592-601. [DOI: 10.1111/j.1365-2702.2008.02732.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Lungen M, Stollenwerk B, Messner P, Lauterbach KW, Gerber A. Waiting times for elective treatments according to insurance status: A randomized empirical study in Germany. Int J Equity Health 2008; 7:1. [PMID: 18184426 PMCID: PMC2246139 DOI: 10.1186/1475-9276-7-1] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2006] [Accepted: 01/09/2008] [Indexed: 11/23/2022] Open
Abstract
Background Health insurance coverage for all citizens is often considered a requisite for reducing disparities in health care accessibility. In Germany, health insurees are covered either by statutory health insurance (SHI) or private health insurance (PHI). Due to a 20%–35% higher reimbursement of physicians for patients with PHI, it is often claimed that patients with SHI are faced with longer waiting times when it comes to obtaining outpatient appointments. There is little empirical evidence regarding outpatient waiting times for patients with different health insurance status in Germany. Methods We called 189 specialist practices in the region of Cologne, Leverkusen, and Bonn. Practices were selected from publicly available telephone directories (Yellow Pages 2006/2007) for the specified region. Data were collected for all practices within each of five specialist fields. We requested an appointment for one of five different elective treatments (allergy test plus pulmonary function test, pupil dilation, gastroscopy, hearing test, MRT of the knee) by calling selected practices. The caller was randomly assigned the status of private or statutory health insuree. The total period of data collection amounted to 4.5 weeks in April and May 2006. Results Between 41.7% and 100% of the practices called were included according to specialist field. We excluded practices that did not offer the requested treatment, were closed for more than one week, did not answer the call, did not offer fixed appointments ("open consultation hour") or did not accept any newly registered patients. Waiting time difference between private and statutory policyholders was 17.6 working days (SHI 26.0; PHI 8.4) for allergy test plus pulmonary function test; 17.0 (25.2; 8.2) for pupil dilation; 24.8 (36.7; 11.9) for gastroscopy; 4.6 (6.8; 2.2) for hearing test and 9.5 (14.1; 4.6) for the MRT of the knee. In relative terms, the difference in working days amounted to 3.08 (95%-KI: 1,88 bis 5,04) and proved significant. Conclusion Even with comprehensive health insurance coverage for almost 100% of the population, Germany shows clear differences in access to care, with SHI patients waiting 3.08 times longer for an appointment than PHI patients. Wide-spread anecdotal reports of shorter waiting times for PHI patients were empirically supported. Discrepancies in access to care not only depend on accessibility to comprehensive health insurance cover, but also on the level of reimbursement for the physician. Higher reimbursements for the provider when it comes to comparable health problems and diagnostic treatments could lead to improved access to care. We conclude that incentives for adjusting access to care according to the necessity of treatment should be implemented.
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Affiliation(s)
- Markus Lungen
- Institute of Health Economics and Clinical Epidemiology, University of Cologne, Gleueler Str, 176 - 178, D-50935 Cologne, Germany.
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