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12-12-2011 | Legal medicine | Article

Academic-affiliated pediatric clinics provide more equitable care

Abstract

Free abstract

MedWire News: Children with public insurance are more likely to be treated at a speciality clinic affiliated with academic medical centers (AMCs) than at nonaffiliated clinics, results of a US audit study show.

However, in the AMC-afflicted clinics, children with public insurance tend to experience significantly longer wait times than children with private insurance.

"Our finding that academic clinics are more willing to serve low-income patients (ie, fewer discriminatory denials) is tempered by evidence of discriminatory service provision," Karin Rhodes (University of Pennsylvania, Philadelphia) and colleagues comment in the Archives of Pediatrics & Adolescent Medicine.

Previous studies suggest that providers of children's outpatient specialty services are less likely to accept Medicaid and the Children's Health Insurance Program (CHIP) than private insurance.

AMCs have features that may encourage equitable access to children, such as large numbers of specialists who see pediatric patients and operate with missions directed toward caring for low-income patients.

Consistent with this rationale, the American Hospital Association found that, while accounting for only 6% of the nation's hospitals, AMCs provide 28% of all discharges of Medicaid enrollees.

"However, recent data highlight that low-income patients are encountering problems accessing specialty care at AMCs," Rhodes et al note.

They therefore performed an audit of 273 specialty clinics serving children residing in Cook County, Illinois.

Trained research assistants posed as mothers attempting to schedule outpatient appointments of moderate severity (ie, same billing code) for children referred for seven pediatric health condition scenarios across eight specialties. Each clinic was called twice using standardized scripts varying only in the child's reported insurance status (Medicaid-CHIP vs the private insurer Blue Cross Blue Shield).

Nearly half (46.8%) of AMC-affiliated clinics in the sample denied an appointment to a child covered by Medicaid-CHIP while accepting a child with private insurance who had the same demographic and clinical presentation.

However, this was a significantly lower rate of discriminatory denials than that observed in clinics without an AMC affiliation (67.2%).

After adjusting for the relevant characteristics of clinics, AMC affiliation was associated with a 45% decrease in the odds of denying Medicaid-CHIP while accepting private insurance (odds ratio=0.55).

However, at academic clinics, wait times were on average 40 days longer for publicly insured children than for children with private insurance. Notably though, median wait times were only 8 days longer, suggesting that while most are providing equitable access, some AMC-affiliated clinics may be de facto denying care through long wait times.

In an accompanying editorial, Stephen Berman (University of Colorado School of Medicine, Aurora) says the findings have special relevance for two current important health policy matters.

"The first is the need for the Department of Health and Human Services and its Centers for Medicare & Medicaid Services to issue detailed compliance standards related to ensuring equal access to health care for children with public insurance.

"The second is the need to continue adequate federal funding for the freestanding Children's Hospitals Graduate Medical Education (CHGME) program."

By Andrew Czyzewski

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