title: Access to appointments based on insurance status in Washington, D.C.
abstract: In the U.S., emergency departments see millions of patients requiring timely and adequate outpatient follow-up. Using a hypothetical patient presenting with a scripted presentation of hypertension evaluated in the emergency department and requiring close outpatient follow-up, randomly selected providers in the District of Columbia were queried by phone to evaluate their accessibility based on insurance status. Seventy one percent of calls for privately insured hypothetical patients resulted in a successful appointment. Medicaid fee-for-service was associated with a significantly lower rate of successful appointments (36.6%) than private insurance (p=.002.) Uninsured "patients" had only a 13% success rate when considering out-of-pocket payment limitations of less than $50 (p<.001 compared with private). Access to primary care follow-up is poor in the District of Columbia for all types of insurance; however people with Medicaid fee-for-service and the uninsured face especially strong barriers.
authors.affiliation: George Washington University Medical School, USA. jblanch@rand.org
authors.forename: Janice
authors.initials: J
authors.lastname: Blanchard
authors.forename: Kathleen
authors.initials: K
authors.lastname: Ogle
authors.forename: Oluwatoyin
authors.initials: O
authors.lastname: Thomas
authors.forename: Derrick
authors.initials: D
authors.lastname: Lung
authors.forename: Brent
authors.initials: B
authors.lastname: Asplin
authors.forename: Nicole
authors.initials: N
authors.lastname: Lurie
mesh_terms: D000328:Adult; D001071:Appointments and Schedules; D003151:Community Health Centers / Q000191:economics* / Q000706:statistics & numerical data; D003266:Continuity of Patient Care / Q000191:economics*; D004219:District of Columbia; D004636:Emergency Service, Hospital; D018588:Fee-for-Service Plans; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000191:economics* / Q000706:statistics & numerical data; D054625:Healthcare Disparities; D006801:Humans; D006973:Hypertension / Q000191:economics* / Q000628:therapy; D019458:Insurance Coverage / Q000145:classification*; D008329:Managed Care Programs; D008484:Medicaid; D006278:Medicare; D010351:Patient Discharge; D016544:Patient Simulation; D011203:Poverty / Q000706:statistics & numerical data*; D015397:Program Evaluation; D014481:United States; D019037:Urban Health Services / Q000191:economics* / Q000706:statistics & numerical data