235343 Dynamics of rationing outpatient subspecialty care for children covered by Medicaid

Sunday, October 30, 2011

Joanna Bisgaier, MSW , School of Social Policy & Practice, University of Pennsylvania, Philadelphia, PA
Karin Rhodes , Department of Emergency medicine School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA
Background: As we move toward covering all Americans, there is need to understand the nuances of barriers to access faced by patients enrolled in Medicaid programs. Individual practices may limit the number of appointments for patients with Medicaid coverage, while still accepting some Medicaid-enrolled patients. However, little is known about institutional strategies used to restrict/provide access to subspecialty services.

Objectives: The purpose of this study was to understand strategies currently in use to ration outpatient appointment slots for pediatric subspecialty care by insurance status.

Method: Between April-September 2009, we used convenience sampling techniques to conduct in-depth confidential interviews (30-90 minutes in length) with a purposeful sample of 14 primary care providers (PCPs) and 30 subspecialty providers working in a large U.S. metropolitan area. Open-ended interviews (in-person or by telephone) were focused on children's access to subspecialty care and conducted until theme saturation was reached. Notes from non-taped interviews (n=2) and transcripts from taped interviews (n=42) were entered into Atlas-TI software and coded to identify themes and patterns within the responses.

Results: Six categories of institutional strategies were identified in the allocation of limited outpatient appointment slots for subspecialty services to Medicaid-insured children: severity of patient's health condition; taking responsibility for patients who lack alternatives; geographic proximity of patient's home address or referring PCP's location; hospital affiliation of PCP; personal connection or professional courtesy with PCP; and informal exchange arrangements with PCP.

Conclusions: Subtle methods of institutional rationing of subspecialty care for publicly-insured children are currently employed in the U.S. health system.

Learning Areas:
Program planning
Provision of health care to the public
Public health or related organizational policy, standards, or other guidelines

Learning Objectives:
Identify and describe institutional strategies currently used to restrict (and selectively allocate) outpatient appointment slots for subspecialty services for children covered by Medicaid.

Keywords: Access to Health Care, Medicaid

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been studying Medicaid and access to subspecialty care for children as a PhD Candidate for three years.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.