Medicaid and access to care among persons with systemic lupus erythematosus.
OBJECTIVE
To evaluate the associations between Medicaid insurance and distance traveled by patients to treating physicians and health care utilization for patients with systemic lupus erythematosus (SLE).


METHODS
A total of 982 adults with SLE were recruited between 2002 and 2004. We calculated the distance between patient homes and physicians using Mapquest, an Internet mapping program. We then assessed the association between Medicaid status and distance traveled to the primary SLE provider, presence of > or =1 physician visits, and the number of all physician visits, with and without adjustment for demographic and medical covariates.


RESULTS
On an unadjusted basis, Medicaid patients traveled longer distances to see their primary SLE provider. This effect was pronounced for patients under the care of a rheumatologist. Adjustment reduced, but did not eliminate, these differences. With adjustment for covariates, Medicaid patients were equally as likely to see a rheumatologist as non-Medicaid patients. However, Medicaid patients were more likely to be seen by a general practitioner or in the emergency room for their SLE, and reported more visits to general practitioners and the emergency room for SLE.


CONCLUSIONS
Medicaid patients with SLE traveled longer distances to see an SLE physician, especially rheumatologists. They also reported a different pattern of health care utilization. These results suggest that Medicaid patients may face barriers in obtaining comprehensive medical services in proximity to their residences.
Gillis
JoAnn Zell
JZ
University of California, San Francisco, CA 94143-0920, USA. joann.gillis@gmail.com
Yazdany
Jinoos
J
Trupin
Laura
L
Julian
Laura
L
Panopalis
Pantelis
P
Criswell
Lindsey A
LA
Katz
Patricia
P
Yelin
Edward
E
D000328:Adult; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000453:epidemiology* / Q000628:therapy*; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D008875:Middle Aged; D010821:Physicians, Family / Q000706:statistics & numerical data; D012219:Rheumatology / Q000706:statistics & numerical data; D014187:Transportation of Patients / Q000706:statistics & numerical data; D014481:United States / Q000453:epidemiology