Medicaid and Children

A google news search for the term “Medicaid” brings up hundreds of results: Medicaid budget cuts, Medicaid access, Medicaid and Planned Parenthood, Medicaid and Obamacare. Pretty much all of them in some way relate to proposed budget cuts and a loss of money going into the program and the potential impact this has on its beneficiaries. Amid all the furor of budgetary woes there is one issue which is gaining a lot of attention. Children on Medicaid are not getting the same level of care as children with private insurance.

In a study published on June 16th 2011 in the New England Journal of Medicine, researchers have found a glaring discrepancy in the treatment of children with private insurance versus children who have Medicaid/CHIP insurance. The study was done in Cook county Illinois and included 273 specialty clinics, clinics that focus on specific disciplines as opposed to a standard primary care physician or family practitioner. Two sets of calls were placed to each clinic included in the study, one where the caller posed as the parent of a child on Medicaid/CHIP and one where the caller posed as the parent of a child with private insurance. Seven different moderately severe medical conditions were used as the reason the child needed an appointment with a specialist: Severe itchy rash lasting longer than 7 months, sleep apnea (obstructed breathing during sleep), childhood diabetes, seizures, fractures that could impact bone growth, severe depression and asthma.

Of these 273 clinics only 94 of them granted appointments to children on Medicaid/CHIP versus the 244 that granted appointments to the children with private insurance. Considering there is a federal law requiring equal access is guaranteed to Medicaid recipients these numbers are beyond unbalanced. Of the 94 that granted appointments to Medicaid/CHIP, five of them turned down patients with private insurance leaving 89 that granted appointments to children in both groups. Of these 89 clinics there were significant disparities in the number of days the patients had to wait between calling for the appointment and the appointment date. On average children with Medicaid/CHIP insurance had to wait 42 more days to be seen by the specialist than children with private insurance. The wait was longest to see a specialist for diabetes and shortest to see a specialist about a broken bone in both groups of patients.

The authors of the study try to address possible explanations for why this disparity occurs by referencing previous studies into Medicaid/CHIP recipients. One obvious reason is that Medicaid pays less than private insurance; they also take longer to pay doctors for services rendered and there is more red tape involved with accepting Medicaid. The overall conclusion seems to be that the current system makes accepting Medicaid less lucrative while requiring more work than private insurance.  

What our state and federal governments needs to address is how to fix the system so all children have equal access to health care that is vital to long term health. During these budget talks it is vital that our politicians realize the impact their decisions will have on the health of children who already aren’t getting the health care they need and deserve.

Sources:  Bisgaier, J, & Rhodes, K. (2011). Auditing access to specialty care for children with public insurance. The New England Journal of Medicine, 364(24), Retrieved from http://www.nejm.org/doi/pdf/10.1056/NEJMsa1013285

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