Insurance status affects ability to secure necessary, timely follow-up medical appointments

September 13, 2005

Callers claiming to have private insurance were much more likely to receive a follow-up appointment within a week for an urgent medical condition than those with Medicaid coverage or without insurance, according to an article in the September 14 issue of JAMA.

According to background information in the article, U.S. residents will make approximately 114 million visits to hospital emergency departments (EDs) in 2005, and more than 80 percent will be treated and discharged with a recommendation for follow-up care. However, many patients, both insured and uninsured, have reported problems making timely follow-up appointments.

Brent R. Asplin, M.D., M.P.H., from Regions Hospital and HealthPartners Research Foundation, St. Paul, Minn., and colleagues examined the access to follow-up appointments according to insurance status in nine U.S. cities from May 2002 to February 2003. Eight research assistants called 499 ambulatory clinics, identifying themselves as new patients who had been seen in an ED and needed an urgent follow-up appointment within one week. Callers read from one of three clinical scenarios requiring follow-up for either pneumonia, hypertension or possible ectopic pregnancy (early pregnancy implanted outside the cavity of the uterus, such as in the Fallopian tube). The same research assistant called each clinic twice using the same scenario but reporting different insurance status.

Of the 499 clinics contacted, 430 completed the study protocol. Four hundred six (47.2 percent) of 860 total callers and 277 (64.4 percent) of 430 privately insured callers were offered appointments within a week. Callers who said they had private health insurance were more likely to receive appointments than those claiming to have Medicaid coverage (63.6 percent vs. 34.2 percent). Those claiming to have private insurance also had higher appointment rates than those who reported having no insurance but offered to pay $20 and arrange payment of balance (65.3 percent vs. 25.1 percent). Researchers found no difference in the appointment rates between callers with private insurance and those uninsured, but willing to pay cash for the entire visit fee (66.3 percent vs. 62.8 percent). The typical charge would have been about $100.

"Regardless of insurance status, 98 percent of clinics contacted in this study screened callers to determine insurance status, whereas only 28 percent attempted to determine the severity of the caller's condition," the authors write.

"These study findings suggest that reported insurance status influences access to follow-up appointments for patients with conditions requiring urgent ambulatory follow-up care," the authors write. "Although the ultimate consequences of these access barriers are not known, they may result in patients' delaying needed follow-up care, risking adverse outcomes, or requiring additional emergency care or hospitalization."
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(JAMA. 2005; 294: 1248 - 1254. Available pre-embargo to media at www.jamamedia.org.)

Editor's Note: Project costs were funded by the Henry J. Kaiser Family Foundation. Dr. Asplin's work was supported by a grant from the Agency for Healthcare Research and Quality.

The JAMA Network Journals

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