Access to Appointments Based on Insurance Status in Washington, D.C.

Published in: Journal of health care for the poor and underserved, v. 19, no. 3, Aug. 2008, p. 687-696

Posted on RAND.org on August 01, 2008

by Janice C. Blanchard, Kathleen Ogle, Oluwatoyin Thomas, Derrick Lung, Brent R. Asplin, Nicole Lurie

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In the U.S., emergency departments see millions of patients requiring timely and adequate outpatient follow-up. Using a hypothetical patient presenting with a scripted presentation of hypertension evaluated in the emergency department and requiring close outpatient follow-up, randomly selected providers in the District of Columbia were queried by phone to evaluate their accessibility based on insurance status. Seventy one percent of calls for privately insured hypothetical patients resulted in a successful appointment. Medicaid fee-for-service was associated with a significantly lower rate of successful appointments (36.6%) than private insurance (p=.002.) Uninsured patients had only a 13% success rate when considering out-of-pocket payment limitations of less than $50 (p<.001 compared with private). Access to primary care follow-up is poor in the District of Columbia for all types of insurance; however people with Medicaid fee-for-service and the uninsured face especially strong barriers.

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