title: Auditing Access to Outpatient Rehabilitation Services for Children With Traumatic Brain Injury and Public Insurance in Washington State.
abstract: To identify insurance-based disparities in access to outpatient pediatric neurorehabilitation services.
  
  
  
  Audit study with paired calls, where callers posed as a mother seeking services for a simulated child with history of severe traumatic brain injury and public or private insurance.
  
  
  
  Outpatient rehabilitation clinics.
  
  
  
  Sample of rehabilitation clinics (N=287): 195 physical therapy (PT) clinics, 109 occupational therapy (OT) clinics, 102 speech therapy (ST) clinics, and 11 rehabilitation medicine clinics.
  
  
  
  Not applicable.
  
  
  
  Acceptance of public insurance and the number of business days until the next available appointment.
  
  
  
  Therapy clinics were more likely to accept private insurance than public insurance (relative risk [RR] for PT clinics, 1.33; 95% confidence interval [CI], 1.22-1.44; RR for OT clinics, 1.40; 95% CI, 1.24-1.57; and RR for ST clinics, 1.42; 95% CI, 1.25-1.62), with no significant difference for rehabilitation medicine clinics (RR, 1.10; 95% CI, 0.90-1.34). The difference in median wait time between clinics that accepted public insurance and those accepting only private insurance was 4 business days for PT clinics and 15 days for ST clinics (P≤.001), but the median wait time was not significantly different for OT clinics or rehabilitation medicine clinics. When adjusting for urban and multidisciplinary clinic statuses, the wait time at clinics accepting public insurance was 59% longer for PT (95% CI, 39%-81%), 18% longer for OT (95% CI, 7%-30%), and 107% longer for ST (95% CI, 87%-130%) than that at clinics accepting only private insurance. Distance to clinics varied by discipline and area within the state.
  
  
  
  Therapy clinics were less likely to accept public insurance than private insurance. Therapy clinics accepting public insurance had longer wait times than did clinics that accepted only private insurance. Rehabilitation professionals should attempt to implement policy and practice changes to promote equitable access to care.
authors.affiliation: Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA; Seattle Children's Research Institute, Seattle, WA; Harborview Injury Prevention and Research Center, Seattle, WA. Electronic address: molly.fuentes@seattlechildrens.org.
authors.forename: Molly M
authors.initials: MM
authors.lastname: Fuentes
authors.affiliation: Seattle Children's Research Institute, Seattle, WA.
authors.forename: Leah
authors.initials: L
authors.lastname: Thompson
authors.affiliation: Harborview Injury Prevention and Research Center, Seattle, WA.
authors.forename: D Alex
authors.initials: DA
authors.lastname: Quistberg
authors.affiliation: Seattle Children's Research Institute, Seattle, WA.
authors.forename: Wren L
authors.initials: WL
authors.lastname: Haaland
authors.affiliation: Hofstra Northwell School of Medicine, Office of Population Health, Great Neck, NY.
authors.forename: Karin
authors.initials: K
authors.lastname: Rhodes
authors.affiliation: Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Kartin
authors.affiliation: Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Kerfeld
authors.affiliation: Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA.
authors.forename: Susan
authors.initials: S
authors.lastname: Apkon
authors.affiliation: Harborview Injury Prevention and Research Center, Seattle, WA; Department of Epidemiology, University of Washington School of Public Health, Seattle, WA.
authors.forename: Ali
authors.initials: A
authors.lastname: Rowhani-Rahbar
authors.affiliation: Seattle Children's Research Institute, Seattle, WA; Harborview Injury Prevention and Research Center, Seattle, WA; Department of Epidemiology, University of Washington School of Public Health, Seattle, WA; Department of Pediatrics, University of Washington School of Medicine, Seattle, WA.
authors.forename: Frederick P
authors.initials: FP
authors.lastname: Rivara
mesh_terms: D000553:Ambulatory Care / Q000706:statistics & numerical data*; D001071:Appointments and Schedules; D000070642:Brain Injuries, Traumatic / Q000534:rehabilitation*; D002648:Child; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D000066530:Neurological Rehabilitation / Q000706:statistics & numerical data*; D014481:United States; D014861:Washington
keywords: Disabled children; Health equity; Health services accessibility; Health services for persons with disabilities; Rehabilitation