Insured, Low-Income Patients Face Hurdles To Health Care Access

Armen Hareyan's picture

Having health insurance is only one of the hurdles that patients have to clear in order to see a doctor these days, according to a new study of Floridians receiving Medicaid.

When interviewers posing as Medicaid patients called doctors' offices that participate in the Florida Medicaid program, they were met in some cases by disconnected numbers, phone trees and time on hold before they could find out about scheduling an appointment.

Weekend and evening appointment times in some instances were scarce and some providers who said they were willing to take new patients proved to be less willing when they found out the new patient was part of the Medicaid program.

The study, which occurred in 2004, found that nearly 87 percent of the doctors in Florida's Medicaid primary care case management program (MediPass) program told the interviewers that they would accept new patients, but only 68 percent said they were accepting new Medicaid patients.

While each of these problems might seem relatively small compared to the lack of insurance that keeps some patients away from regular care, Allyson Hall, Ph.D., and colleagues at the University of Florida argue that they can affect access to health care in significant ways.


"If an individual has a particularly difficult time getting in to see the usual physician, we could reconsider whether that physician is actually acting as a regular source of care for that patient," the researchers write in the May 2008 issue of the Journal of Health Care for the Poor and Underserved.

A 2007 study by researchers at the Oregon Health and Science University led by Jennifer DeVoe, M.D. found that low-income families in Oregon that have insurance often travel miles to find doctors. DeVoe said the maxim of these families could be, "We have health insurance, but we can't always find the care that we need."

In the Florida study, the researchers collected information on the calls made to doctors in MediPass, noting how many times the phone rang before it was answered, how long the interviewers spent on hold and how many times they were transferred "in order to capture the so-called hassle factor involved in trying to get an appointment," Hall and colleagues said.

About 22 percent of the calls went unanswered the first time the interviewers tried the number, 17 percent of interviewers had their call transferred and 18 percent of answered calls automatically went to a phone tree. The interviewers landed on hold for an average of four minutes, the researchers calculated.

More than two-thirds of the doctors said they would not schedule appointments outside of typical work week hours. Hall called the number "extraordinarily high," noting that Florida's Medicaid program requires doctors to have evening and weekend hours and a way to contact them after hours.

Most Florida Medicaid patients lived within 30 minutes of a Medicaid-participating doctor, and nearly two-thirds of the doctors could schedule an appointment within a week of calling. However, only 35 percent of gynecologists were able to schedule a new patient within a week, compared with 72 percent of pediatricians.