Doctor Shopping Study Shows Access to Doctors is Not Equal


Access to doctors is usually thought to be an issue for Americans that live without health insurance. However, for the many Americans that receive public insurance, such as through Medicaid and the Children’s Health Insurance Program (CHIP), access to a physician is also a concern.

Due to differences in how much doctors are paid by private insurance companies and public insurance programs, there is concern that doctors give scheduling priority to patients who have private insurance. According to the New York Times, many doctors refuse to take Medicaid recipients as patients due to the low payments for services and repeated threats to cut Medicaid fees.

To check if doctors truly gave scheduling preference to patients with private insurance, the Obama Administration proposed randomly auditing doctors from around the country. Often called “doctor shopping,” the audit would consist of calling doctors’ offices with callers posing as new patients looking to schedule an appointment. Using a script, two calls would be made -one stating the caller had private insurance and one stating the caller had public insurance – both would give the offices symptoms of conditions that require “urgent” evaluation.

After the calls are made, the information gathered, such as how many days from the call the appointment is scheduled for, would be able to indicate if patients with private insurance receive priority. Time reports that following an outcry from the medical community the Obama Administration’s auditing plan was scrapped; however, other studies using the same or similar methods have been conducted.

A recent New England Journal of Medicine (NEJM) study confirms what the Obama Administration may have feared, that doctors really due give scheduling preference to patients with private insurance. Specifically, the study found that children on public insurance who required urgent care or evaluation had a longer average wait for an appointment than children with private insurance. Longer waits may lead to delayed diagnosis with potentially severe consequences.

With more Americans set to receive Medicaid in 2014, when the new health care law takes effect, making sure that Americans receiving public insurance have access to doctors is important. Doctor shopping/audit studies, as argued by Time, are a method that the government and other health care advocates can use to ensure that everyone has access to quality care in an equal manner.

Source: Time, Why Secret Doctor Shopping Studies Are Necessary, Dr. Zachary F. Meisel and Dr. Jesse M. Pines, 15 August 2011

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