Doctors disfavor kids with public insurance

Children with public health insurance — namely Medicaid and the Children’s Health Insurance Program — face significantly lower access to specialty health care than those with private insurance, according to a recent Penn study.

The study, published earlier this month in The New England Journal of Medicine, was conducted in Cook County, Ill., which has a high volume of specialty physicians — 218 specialists per 100,000 residents, versus the national median of 32 to 100,000.

Research assistants called a given clinic twice over a one-month interval, posing as mothers seeking specialty care for their children with conditions such as asthma, seizures and bone fractures. The only difference between the calls was the insurance status used by the caller.

The study found that 66 percent of callers saying they had public insurance were denied an appointment — versus only 11 percent of those saying they had private insurance.

Even getting an appointment didn’t guarantee prompt care. Publicly insured callers who were able to get an appointment had to wait an average of 22 days longer for their appointments than privately insured callers.

Karin Rhodes, an assistant professor and director of Health Care Policy Research at the Perelman School of Medicine and one of the study’s two authors, wrote in an email that she “was very disappointed to find this level of disparity in access for children with serious health conditions.”

“I would much have preferred to have found equal access to care and it would be equally publishable,” Rhodes added.

Children covered by public insurance options like Medicaid or CHIP “may face greater barriers to specialist care as a result of fewer resources within their families, including lower levels of income, education, language proficiency and health literacy,” the study states.

Additionally, “low-income Americans, racial and ethnic minorities and other underserved populations often have higher rates of disease, fewer treatment options, and reduced access to care,” according to the U.S. Department of Health & Human Services.

“This study was able to define the problem more completely and precisely than prior work, but more research is needed to understand the benefits or opportunity costs of potential policy changes,” School of Social Policy and Practice doctoral student and co-author of the study Joanna Bisgaier wrote in an email.

The dire financial straits of various states, and the country in general, pose a threat to public insurance programs. “Cuts to Medicaid budgets at federal and state levels run serious risk of making this problem worse, especially for the tens of millions of American children are covered by Medicaid,” Evan Fieldston, an assistant professor in the School of Medicine, explained.

“In the long-run, this pennywise, pound-foolish approach will hurt us as a nation, with a population that is less well and less productive,” Fieldston added.

Richard Cooper, a professor in the School of Medicine, suggested that the disparities in health care access mentioned in the study can be attributed to a dearth of physicians in the U.S.

“After 30 years of a deliberate national policy to reduce the number of physicians, success can be declared. There are too few,” he said, “and the poor suffer most.”

While raising fees that Medicaid and CHIP pay to specialty doctors could make patients more “financially attractive to treat,” such an option is unlikely to be approved by taxpayers, Mark Pauly, a Health Care Management professor in Wharton, said.

“Until taxpayers can be convinced that it is worth their paying higher taxes to help those on public insurance,” he said, “nothing can be done.”

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