Today's News

Thursday, February 6, 2003

Children with Medicaid have less access to orthopedic care

In a nationwide sample, children insured with Medicaid have significantly less access to orthopaedic care than children with private insurance, in violation of federal guidelines, said the authors of Scientific Paper 001 yesterday.

The results of their national survey on access to timely orthopaedic care for children with Medicaid showed that Medicaid physician reimbursement for an office consultation correlates significantly with patient access to medical care. Federal guidelines require physician payments be sufficient to enlist enough providers so that services to Medicaid recipients are available to the same extent as those available to the general population.

A previous study found children insured by Medicaid in California have less access to orthopaedic care than children with private insurance. Researchers examined whether a similar difference in access to orthopaedic care exists nationally, and if the difference is related to local Medicaid physician reimbursement.

The offices of 150 orthopedic surgeons were selected at random, three from each of 50 states. Two phone calls were made to each office at three-week intervals:

Researchers found that 100 percent of children with private insurance were offered appointments at the 150 practices, but only 65 percent of children with Medicaid were given appointments (p< .01).

The relationship between local reimbursement rates and access was statistically significant for CPT 99243, Office Consultation (p> .02).

"We believe that many - if not most - doctors would welcome the opportunity to serve their community and see poor patients free of charge," study authors wrote. "Studies have consistently demonstrated that one of the primary motivations for becoming a physician is the desire to help people. Unfortunately, donating one's service is difficult for physicians in the current healthcare system. If an orthopedic surgeon sees an established patient for follow-up of an arm fracture, the mean Medicaid reimbursement of $33.59 minus the mean office expense of $189.59, means the physician must pay $156 for the visit."

Study authors include: David L. Skaggs, MD, Samantha Clemons, and Robert M. Kay MD, all of Los Angeles; and Rebecca M. Bauer and Michael G. Vitale, MD, MPH, both of New York.

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Last modified 20/January/2003