Study finds no evidence docs provide less care to safety net patients
By Steven Ross Johnson
A study found no evidence that primary-care physicians spend less time with safety net patients and the uninsured than with privately insured patients, countering longstanding assumptions that doctors give less attention to Medicaid and uninsured patients.
The study in the September issue of the journal Health Affairs looked at the amount of time physicians spent with patients and found no significant differences between those with private insurance and patients with Medicaid or those uninsured.
“We found that doctors were treating patients based on their individual needs,” said Brian K. Bruen, study lead author and lead research scientist in the Department of Health Policy at George Washington University's School of Public Health and Health Services. “I think we'll see that sort of pattern continue under the ACA expansion.”
Bruen said the study found that primary-care physicians spent on average 18 minutes with each patient, and a longer period with new patients and those with serious medical conditions, regardless of the type of coverage.
Some observers have claimed that low Medicaid payments have led doctors to spend less time with Medicaid patients. But the study debunks that claim.
The study did not examine, however, whether Medicaid and uninsured patients have equal access to physician and other healthcare services. Many providers serving low-income patients, such as federally qualified community health centers, say it's hard to arrange specialty physician care, tests and other services for these patients.
“There are a lot of studies that show worse outcomes for Medicaid patients compared not only to private insurance, but also in some cases to uninsured people,” said Chris Holt, healthcare policy director at the American Action Forum, a conservative policy research institute. “But I think it's not an issue with the quality of care they are receiving, it's an access issue. When you're on Medicaid, you have more access barriers than you do in private insurance.”
Bruen said the Medicaid expansion in 2014 under the Patient Protection and Affordable Care Act, which will extend coverage to millions of uninsured Americans, could make it even more difficult for some beneficiaries to get timely access to care. “There will be places in the country where people will have difficulty accessing primary-care services as a result of the expansion, but provider shortages may already be a problem in many of these areas,” he said.
Despite the pressures, Bruen said he did not expect doctors to start limiting the time they spent with patients as a result of the expansion.
According to research from the Kaiser Family Foundation, children and adults with Medicaid coverage are better off than uninsured patients in terms of access to care and utilization of services. And Medicaid beneficiaries have utilization rates of preventive services, such as routine check-ups, mammograms and flu vaccinations that are comparable to privately insured patients.
Bruen said it was nearly impossible to determine how the expansion would ultimately impact care, but pointed out there were a number of provisions outlined within ACA designed to increase primary-care access.
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