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New Study: Medicaid’s Access Problem With Dentists and Clinics

by Benjamin Domenech on May 25, 2011

Maureen Salmon at U.S. News & World Report reports on a disturbing new study.

Undercover research in Illinois reveals that dentists are far more willing to provide emergency care to children with private insurance than to kids with public insurance such as Medicaid.

Posing as mothers of a fictional 10-year-old boy with a fractured front tooth, six research assistants phoned 85 dental practices twice, four weeks apart, to determine the impact of insurance status on the practices’ decision to schedule an urgent dental appointment.

Even when calling Medicaid-enrolled dentists, just 68 percent of children with the Medicaid/Children’s Health Insurance Plan were able to get an appointment, compared to all of the privately insured children. Non-enrolled dentists offered an appointment to only 7 percent of kids with public insurance despite the fact that Medicaid reimburses all emergency dental care.

“That’s a huge difference,” said study co-author Dr. Karin Rhodes, director of the division of emergency care policy research at the University of Pennsylvania’s School of Social Policy and Practice. “This gives irrefutable numbers. I think there’s a real disparity between oral health and traditional medical care in this country.”

The abstract of the study, published today in the journal Pediatrics, is here. Prior studies, such as this large one from the RAND Corporation, have indicated that the type of insurance individuals have (including whether they are uninsured) does not affect the quality of care they receive. This is good news, indicating that medical professionals are, well, professional, and don’t offer poor coverage to Medicaid patients just because of the population they’re in.

What this leaves out is the percentage of people who never receive care at all. As we document throughout this site, Medicaid does not provide real access: instead, it effectively limits your ability to receive non-emergency care. Indeed, a study on primary care appointments found that it’s actually easier to get one if you’re uninsured, and only marginally better than if you’re uninsured and offer to pay just $20 at the time of the appointment, and the balance later. Access varied with reimbursement rates and other factors – the worst scenario was in Denver, Colorado:

From the study:

Callers recorded the reasons they were refused appointments (Table 2). Callers who claimed to have Medicaid coverage were generally told that the clinic did not accept Medicaid; this was true for 74.6% (91/122) of the Medicaid callers who were refused appointments. Callers claiming to be privately insured who were refused appointments, in contrast, were generally told either that the clinic was not accepting new patients at that time (31.1% [19/61] of callers) or that no appointment times were available soon enough to meet the caller’s needs (23.0% [14/61] of callers). Of the 199 callers who claimed to be uninsured, 125 were initially offered an appointment under the assumption that they would pay cash for their visit. Clinics subsequently refused appointments to 75 of these 125 callers when a request was made to pay $20 at the time of the visit and arrange payment for the balance…

In light of known relationships between health insurance and access to care in the United States, it is not surprising that callers who are uninsured face barriers to securing timely access to follow-up care. It may be surprising to some that appointment rates for callers covered by Medicaid were only marginally better than those for uninsured callers who offered to pay $20. This raises questions about the adequacy of Medicaid reimbursement for outpatient care.

If having Medicaid is functionally worse at allowing access to needed care than being uninsured, there’s little question it’s failing in its mission.

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