Even when they suffer serious medical conditions, children covered by Medicaid are much more likely than privately insured youngsters to be refused treatment by medical specialists or to be forced to wait more than a month for an appointment, according to a study published in the New England Journal of Medicine.
As The New York Times reports, researchers largely blamed Medicaid’s lower payments, delays in paying and red tape.
Posing as the parent of a sick or injured child, researchers called 273 specialty practices in Cook County, Ill., which includes Chicago, to schedule appointments. The researchers described such problems as diabetes, seizures, asthma, broken bones or severe depression. Overall, 66 percent of those who mentioned Medicaid-CHIP (Children’s Health Insurance Program) were denied an appointment, versus 11 percent of those with private insurance.
Among the 89 clinics that accepted both types of insurance, the average wait for an appointment for children said to be covered by public insurance was 22 days longer than it was for the privately insured, the study found.
Researchers noted that in Illinois, Medicaid will pay $99.86 for a doctor visit for a problem of “moderate severity,” while private insurers pay an average of $160, and many doctors said they could not sustain their practices if they accepted too many Medicaid patients. Specialists affiliated with academic medical centers said they are under pressure to generate more revenue by seeing patients who are privately insured.
Dr. Karin V. Rhodes, an author of the study and an emergency care policy researcher at the University of Pennsylvania, told the Times that public insurance programs are being strained to the breaking point.
“If we keep whittling away at them, it will hurt children and adults alike,” she said.
Rhodes’s research stemmed from a lawsuit against the state of Illinois, Memisovski v. Maram, in which a judge found that children on Medicaid did not have the same access to preventive care as did those who were privately insured. The case led to higher payment rates and other reforms in Illinois, and also a requirement that the state pay for a study of low-income children’s access to medical specialists.
Dr. Rhodes was asked to conduct the study.
“The disparity held across every specialty that was tested,” Dr. Rhodes said. “This is systemic.”
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