title: Academic medical centers and equity in specialty care access for children.
abstract: OBJECTIVE
  To test whether specialty clinics' academic medical center (AMC) affiliation was associated with equity in scheduling appointments for children with public vs private insurance. Academic medical centers are safety-net providers of specialty medical care and it is unknown whether equitable access is afforded by AMCs across insurance conditions.
  
  
  METHODS
  Audit study data were linked to data describing audited clinics.
  
  
  METHODS
  Specialty clinics serving children residing in Cook County, Illinois.
  
  
  METHODS
  From January-May 2010, 273 clinics were each called twice.
  
  
  METHODS
  Logistic regression was used to examine associations between AMC affiliation and discriminatory denials of Medicaid-Children's Health Insurance Program (CHIP) (ie, nonacceptance of Medicaid-CHIP when accepting commercial insurance), controlling for clinics' specialty type, practice size, neighborhood poverty level, and physicians' credentials. Among clinics that accepted both insurances, linear regression was used to examine the association between wait times (days) for appointments and insurance status, adjusting for covariates. Tests for interaction terms were performed to identify changes in wait time for academic clinics across insurance status.
  
  
  RESULTS
  Of the 273 paired calls to clinics, 155 (57%) resulted in discriminatory denials of Medicaid-CHIP. The odds of a discriminatory denial were 45% lower if a clinic was AMC affiliated (odds ratio, 0.55; 95% CI, 0.31-0.99). On average, academic clinics scheduled Medicaid-CHIP appointments with wait times 40 days longer than private insurance (β, 40.73; 95% CI, 5.06-76.41).
  
  
  CONCLUSIONS
  Affiliation with an AMC was associated with fewer discriminatory denials of children with Medicaid-CHIP. However, children with Medicaid-CHIP had significantly longer wait times at AMC-affiliated clinics compared with privately insured children. Academic medical centers' propensity toward serving publicly insured patients makes them candidates for targeted resource allocation, perhaps with incentives contingent on equitable appointment acceptance and wait times.
authors.affiliation: School of Social Policy & Practice , University of Pennsylvania, Philadelphia, PA 19104, USA.
authors.forename: Joanna
authors.initials: J
authors.lastname: Bisgaier
authors.forename: Daniel
authors.initials: D
authors.lastname: Polsky
authors.forename: Karin V
authors.initials: KV
authors.lastname: Rhodes
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration*; D000293:Adolescent; D001071:Appointments and Schedules; D002648:Child; D002675:Child, Preschool; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration*; D006801:Humans; D007087:Illinois; D007223:Infant; D007231:Infant, Newborn; D019458:Insurance Coverage / Q000191:economics*; D007348:Insurance, Health / Q000191:economics*; D008297:Male; D008484:Medicaid / Q000191:economics*; D008511:Medicine; D012189:Retrospective Studies; D014481:United States