Will there be enough doctors? JAMA evaluates access to physicians

58% of Medicaid beneficiaries are able to make a primary care appointment

A patient's chance of getting an appointment with a new primary care physician (PCP) may depend on their insurance, according to a new study in JAMA Internal Medicine assessing access to care on the eve of the Affordable Care Act (ACA) rollout.

Get primed: What parts of the Affordable Care Act are being rolled out in 2014?

For the study, University of Pennsylvania researchers called nearly 8,000 PCPs in 10 states from November 2012 to April 2013 and asked to make an appointment for a patient with private insurance, one with Medicaid, or an uninsured patient who would be paying out of pocket.

"We wanted to know if there was enough primary care capacity in the system to allow for the new enrollees coming in," lead author Karin Rhodes says, adding, "Given that access to primary care is considered a prerequisite for improved population health outcomes, a strained primary care system may place many of the goals of the ACA at risk."

The researchers found that:

  • 85% of patients with private insurance were able to make appointments;
  • 79% of patients paying out of pocket were able to make appointments;
  • 58% of Medicaid beneficiaries were able to make appointments.

Although the majority of uninsured patients were able to obtain an appointment, just 15% were given a payment option that included paying $75 or less upfront, researchers write.

For patients who did receive an appointment, the median wait time was less than one week, and three-quarters of patients were given an appointment within two weeks. 

Overall, Rhodes says the study indicates that the U.S. health system has the capacity to handle an influx of newly insured patients under the ACA. And, despite criticisms of the program, "Medicaid provides a lot more access than being a low-income, uninsured person."

However, the study notes that access to physicians varies significantly by state and insurance status. The researchers recommend the adoption of navigator programs that help patients enroll in coverage and identify practices accepting patients in their network.

Moreover, Andrew Bindman—a researcher at the Philip R. Lee Institute for Health Policy Studies at the University of California-San Francisco—called for a closer look at difference in access to care between Medicaid beneficiaries and privately insured patients.

In an accompanying editorial, Bindman wrote that the study suggests that "Medicaid beneficiaries' options may be limited" even before expansion. He said, "The addition of so many new enrollees into this program could put additional stress on a pool of physicians who were already stretched to meet the needs of Medicaid beneficiaries prior to this expansion" (Seaman, Reuters, 4/7; Rhodes et al., JAMA Internal Medicine, 4/7).

How many doctors does your network need?

Several Advisory Board resources offer tactics to help deal with the patient access challenge.

  • A new Medical Strategy Group Council white paper reviews three key factors to determine how many doctors your network needs.
  • In a video briefing, Southwind's Ayal Bitton shares what his own experiences taught him about the importance of having a robust patient access strategy, and shares three strategies for managing the challenge.
  • Our Health Insurance Status Profiler allows you to examine insurance coverage levels in your local market. Use the profiler now.

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