ACCESS OF MEDICAID RECIPIENTS TO OUTPATIENT CARE

Background. Visits to the emergency department by Medicaid recipients for nonemergency problems are common and contribute to rising health c are costs. However, such patients may have few alternatives. We conduc ted a telephone survey of 953 ambulatory care sites in 10 cities to de termine the availability of appointments for Medicaid recipients with common problems. Methods. Research assistants telephoned all ambulator y care clinics and a stratified sample of private primary care practic es in the catchment area served by the hospital emergency department i n each city. The assistants identified themselves as Medicaid recipien ts seeking care for one of three problems (low back pain, dysuria, or sore throat) and asked a standardized series of questions. Data were c ollected on appointments or walk-in visits authorized at any time, wit hin two days after the call, or after 5 p.m.; copayment requirements; and reasons appointments could not be made. If an appointment was made , it was canceled at the end of each call or shortly thereafter. Sever al weeks later, private-practice sites in six of the cities were recon tacted; the research assistants identified themselves as patients with private insurance and the same problem. Results. An appointment or an authorization for a walk-in visit was obtained from 418 of the 953 pr actice sites (44 percent); 47 of the sites (5 percent) could not be co ntacted. Appointment rates for the different types of sites ranged fro m 72 percent for free-standing urgent care centers to 34 percent for p rivate practices. ''Not accepting Medicaid'' was the most common reaso n given for not granting an appointment or walk-in visit. Only 72 of t he sites (8 percent) offered after-hours care within two working days after the call without a cash copayment. Sixty percent of the 330 priv ate practices that were recontacted agreed to see a patient with priva te insurance within two working days, but only 26 percent agreed to se e a patient with Medicaid within two days (P<0.001). Conclusions. Medi caid recipients in urban areas have limited access to outpatient care apart from that offered by hospital emergency departments.