title: Primary care appointment availability and nonphysician providers one year after Medicaid expansion.
abstract: With insurance enrollment greater than expected under the Affordable Care Act, uncertainty about the availability and timeliness of healthcare services for newly insured individuals has increased. We examined primary care appointment availability and wait times for new Medicaid and privately insured patients before and after Medicaid expansion in Michigan.
  
  
  
  Simulated patient ("secret shopper") study.
  
  
  
  Extended follow-up of a previously reported simulated patient ("secret shopper") study assessing accessibility of routine new patient appointments in a stratified proportionate random sample of Michigan primary care practices before versus 4, 8, and 12 months after Medicaid expansion.
  
  
  
  During the study period, approximately 600,000 adults enrolled in Michigan's Medicaid expansion program, representing 57% of the previously uninsured nonelderly adult population. One year after expansion, we found that appointment availability remained increased by 6 percentage points for new Medicaid patients (95% CI, 1.6-11.1) and decreased by 2 percentage points for new privately insured patients (95% CI, -0.5 to -3.8). Over the same period, the proportion of appointments scheduled with nonphysician providers (nurse practitioners or physician assistants) increased from 8% to 21% of Medicaid appointments (95% CI, 5.6-20.2) and from 11% to 19% of private-insurance appointments (95% CI, 1.3-14.1). Median wait times remained stable for new Medicaid patients and increased slightly for new privately insured patients, both remaining within 2 weeks.
  
  
  
  During the first year following Medicaid expansion in Michigan, appointment availability for new Medicaid patients increased, a greater proportion of appointments could be obtained with nonphysician providers, and wait times remained within 2 weeks.
authors.affiliation: Department of Internal Medicine, Division of General Medicine, University of Michigan, North Campus Research Complex, Bldg 16, Rm 472C, 2800 Plymouth Rd, Ann Arbor, MI 48109-2800. E-mail: rtipirne@med.umich.edu.
authors.forename: Renuka
authors.initials: R
authors.lastname: Tipirneni
authors.forename: Karin V
authors.initials: KV
authors.lastname: Rhodes
authors.forename: Rodney A
authors.initials: RA
authors.lastname: Hayward
authors.forename: Richard L
authors.initials: RL
authors.lastname: Lichtenstein
authors.forename: HwaJung
authors.initials: H
authors.lastname: Choi
authors.forename: Elyse N
authors.initials: EN
authors.lastname: Reamer
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Davis
mesh_terms: D001071:Appointments and Schedules; D005260:Female; D018166:Health Care Reform; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008484:Medicaid / Q000458:organization & administration*; D008824:Michigan; D009722:Nurse Practitioners / Q000191:economics / Q000600:supply & distribution*; D017063:Outcome Assessment, Health Care; D058991:Patient Protection and Affordable Care Act; D016544:Patient Simulation; D011320:Primary Health Care / Q000458:organization & administration*; D018570:Risk Assessment; D014481:United States; D014850:Waiting Lists