Access to orthopedic care for children with Medicaid versus private insurance in California

Objective. To compare the availability of timely orthopedic care to a child with a fractured arm insured by Medi-Cal (California state Medicaid) and b y private insurance. Study Design. Fifty randomly chosen offices of orthopedic surgeons were tel ephoned with the following scenario: "My 10-year-old son broke his arm last week during a vacation" followed by a request for an appointment that week . Each office was called twice with an identical script except for insuranc e status: once with Medi-Cal and once with private insurance. Results. All 50 offices offered an appointment to see the child with privat e insurance within 7 days. Only 1 of the same 50 offices offered an appoint ment to see the child with Medi-Cal within 7 days. Of the offices that woul d not see a child with Medi-Cal, 87% were unable to recommend an orthopedic office that accepted Medi-Cal. Conclusions. Timely access to orthopedic care was available in 100% of offi ces polled to a child with private insurance versus in 2% of offices to a c hild with Medi-Cal. This is a significant difference. Lack of timely orthop edic care may result in poor outcome, ie, if a fracture is not properly ali gned in the first few weeks, a permanent deformity may result. Although cau sation cannot be established from this study, we suspect that Medi-Cal reim bursement rates below the cost of office overhead may be of significance. A lthough federal guidelines require that payments must be sufficient to enli st enough providers so that services to Medi-Cal recipients are available t o the same extent as those available to the general population, this study finds that that children with Medi-Cal insurance have significantly less ac cess to timely orthopedic care.