By Suzanne Berman, MD
The Obama administration recently announced plans to use a series of “mystery shoppers” to see whether it’s true that patients with Medicaid have problems getting appointments with doctors.
This isn’t just idle curiosity; Medicaid patients are supposed to get care equal to privately-insured individuals. The equal access provision of the Medicaid Act, 42 U.S.C. § 1396a(a)(30)(A), states that:
“A state plan for medical assistance must . . . provide such methods and procedures relating to the utilization of and the payment for, care and services available under the plan to assure that payments are consistent with efficiency, economy, and quality of care and are sufficient to enlist enough providers so that care and services are available under the plan at least to the extent that such care and services are available to the general population.”
While I’m pleased to see that someone at the federal level appears to be paying attention to Medicaid access problems, this initiative wasn’t all that novel, and in fact seems downright redundant: for years, doctors have been documenting the difficulties with Medicaid access in peer-reviewed medical journals.
About ten years ago, pediatrician and AAP president Steve Berman published a study that documented that, nationally, children with Medicaid indeed had much poorer access to private pediatricians than their privately-insured counterparts. Based an excellent cross-sectional survey of private pediatricians nationwide, its results were impressive for their comprehensiveness; the conclusion wasn’t that surprising or novel, even in 2002.
Since then, the Medicaid/private insurance access to appointments disparity has been studied broadly, again and again – with strikingly similar results every time. Just a few of the studies conducted within the past decade (many of which have even used the “mystery shopper” technique) include evaluation of:
- eight types of pediatric specialists in Chicago (2010)
- South Florida orthopaedic surgeons (2010)
- California orthopaedic surgeons (2001)
- Southern California urologists (2005)
- Southern California ENTs (2003)
- orthopaedic surgeons in all 50 states (2006)
- Florida primary care doctors (2003)
- dermatologists nationwide (2003)
- mental health providers nationwide (2008)
- Illinois dentists (2010)
Even yours truly at Survivor: Pediatrics compiled a survey of Tennessee pediatricians showing that Medicaid-insured children in Tennessee do not have the access to pediatricians enjoyed by their privately-insured counterparts.
A few days after its announcement, the Obama administration announced that it was cancelling its mystery shopper initiative. Hopefully, someone decided that re-inventing the wheel wasn’t necessary after all.
Suzanne Berman is a practicing general pediatrician in rural Tennessee. Her study of Medicaid access was supported by a grant from the American Academy of Pediatrics’ Community Access to Child Health (CATCH) program.