In Illinois Medicaid kids suffer bias in getting treatment at Cook County clinics: June 16, 2011

Chicago Sun-Times : with MONIFA THOMAS : June 16, 2011

Children on Medicaid are much more likely than kids with private health insurance to be denied appointments with medical specialists, and they wait longer on average to be seen, according to a “secret shopper” study of Cook County clinics.

Two-thirds of fictitious Medicaid patients were denied appointments compared to 11 percent of privately insured patients, researchers reported in Thursday’s New England Journal of Medicine.

Research assistants posing as mothers of sick children called to make appointments for specialty care at 273 clinics one month apart. In one call, they told the clinic they had public insurance. In the other, they said they were privately insured.

In 89 clinics that accepted both types of insurance, children with public insurance also waited 22 days longer on average for an appointment with a specialist.

And in more than half of the phone calls, the caller was asked what kind of insurance their child had before an appointment could be scheduled.

Low reimbursement rates, payment delays and hassles associated with the payment process were cited by the study’s authors as likely reasons for doctors’ reluctance to see Medicaid patients.

The study is the most comprehensive yet to show that children on public insurance have a harder time accessing specialty care, even when they have serious conditions, said lead author Dr. Karin Rhodes, an emergency medicine specialist at the University of Pennsylvania.

Among the fictitious patients researchers tried to make appointments for were an 8-year-old who had recently had a seizure, a 13-year-old with severe depression and a 14-year-old with uncontrolled asthma.

“To the person on the other end of the call who was not giving them an appointment, these were real children,” Rhodes said. “The results were disturbing in that way because we want all children to have the opportunity to see a doctor when they need one.”

Rhodes said the findings likely are not unique to Cook County. Solutions include strengthening the primary care infrastructure to make referrals to specialists easier for patients and restructuring the payment system, so that doctors have an incentive to see public insurance patients.

The study was funded by the Illinois Department of Healthcare and Family Services as part of a consent decree stemming from a 2005 class-action lawsuit alleging that young Medicaid recipients in Cook County were denied equal access to primary care.

Department spokesman Mike Claffey said the research “highlights an issue that has been and continues to be an area of focus” for Medicaid programs in every state.

Illinois is “studying new service delivery models, as well as new payment systems that provide an incentive for better quality outcomes,” Claffey said.