Children on public insurance are being denied treatment by doctors at much higher
rates than those with private coverage, according to an undercover study that had
researchers pose as parents of sick kids seeking an appointment with a specialist.
Snubbed even by specialists whose offices supposedly accept public insurance
patients, these kids also had to wait much longer to see a doctor. Low Medicaid
reimbursements are the likely reason, the study authors said.
The study was done in Cook County, Ill., the nation's second-most populous
county which includes Chicago, but the researchers and others say the results
likely reflect practices around the country.
"People should be very concerned," said Dr. Karin Rhodes, the lead author and an
emergency medicine specialist at the University of Pennsylvania.
The study results suggest many of the 40 million publicly insured U.S. children are
not getting recommended timely treatment for dangerous conditions including
asthma, diabetes and depression, she said.
"I work in an emergency room ... where you see the long-term consequences of
people who did not get the care they needed," Rhodes said.
The study appears in Thursday's New England Journal of Medicine.
The study is "simple and elegant" and bolsters previous research while presenting
a more accurate real-world picture of disparities facing public aid patients, said Dr.
Steve Wegner, former head of the American Academy of Pediatrics' child health
To test whether type of insurance influences doctors' willingness to schedule
appointments, the researchers posed as parents of fictitious sick children referred
to specialists by primary-care doctors or emergency room physicians. Seven
scenarios were created, including a 9-month-old with a severe skin rash, a 7-year
old with diabetes, a 12-year-old with a suspected broken arm and a 13-year-old
with symptoms of severe depression.
The researchers phoned 273 specialty clinics twice, a month apart, seeking an
appointment with doctors including dermatologists, allergists, psychiatrists and
bone specialists. In one call, the children were said to have private insurance; in
the other, they were insured through Illinois' Medicaid program.
Overall, specialists refused to grant appointments for 66% of the Medicaid
children, versus only 11% of privately insured youngsters.
Among 89 clinics that accepted both insurance types, Medicaid children had to wait
an average of 42 days for an appointment, versus 20 days for private coverage.
Now, remind me, how exactly would splitting up Medicaid funding into state-by-
state block grants help this situation?