Do Clinics Favor Insured for Follow-Up Visits?

Sept. 13, 2005 - People covered by private health insurance may be more
likely to receive follow-up care within a week for an urgent medical condition
than those with Medicaid or without health insurance.
A new study shows that callers claiming to have private health insurance
were about twice as likely to get a follow-up appointment at an ambulatory
clinic within a week after an emergency room visit than those without insurance
or with Medicaid.
The results suggest that callers’ health insurance status may be more
important to most people answering the phones and scheduling appointments at
ambulatory care clinics than their health status.
Researchers say that while 98% of the clinics contacted screened callers for
health insurance status, only 28% attempted to determine the severity of the
callers’ medical condition.
Health Insurance Makes a Difference
Researchers say Americans will make about 114 million visits to hospital
emergency departments in 2005 and more than 80% will be treated and discharged
with recommendations for follow-up care. But many uninsured people often
experience problems making follow-up appointments within the recommended time
frame.
In the study, published in The Journal of the American Medical
Association, researchers looked at the role insurance status plays in
securing a follow-up appointment for an urgent medical condition identified
during an emergency room visit.
Research assistants made calls to nearly 500 ambulatory clinics in nine U.S.
cities from May 2002 to February 2003 and identified themselves as new patients
who had been treated in an emergency room and required an urgent follow-up
appointment within a week. Callers read a script detailing one of three
possible medical scenarios requiring follow-up, including pneumonia, high blood
pressure, or a possible ectopic pregnancy (a potentially life-threatening,
early pregnancy occurring outside the uterus, such as within the fallopian
tube).
The same assistant called each clinic twice with the same medical scenario
but with a different insurance status.
Insured vs. Noninsured: Getting an Appointment
The results showed that the availability of follow-up appointments varied
according to insurance status. For example:

64% of callers with private insurance were offered a follow-up appointment
within a week vs. 47% of callers overall.
Callers with private health insurance were more likely to receive
appointments than those claiming to have Medicaid coverage (64% vs. 34%)
Callers with private health insurance also had higher appointment rates
than those without insurance who offered to pay $20 and arrange for payment of
the balance (65% vs. 25%)

But researchers found no difference in follow-up appointment rates between
those with private insurance and uninsured people willing to pay cash for the
entire visit fee (about $100 for a typical visit).
“These study findings suggest that reported insurance status influences
access to follow-up appointments for patients with conditions requiring urgent
ambulatory follow-up care,” write researcher Bret Asplin, MD, MPH, of the
department of emergency medicine at Regions Hospital and HealthPartners
Research Foundation in St. Paul, Minn., and colleagues. “Although the
ultimate consequences of these access barriers are not known, they may result
in patients delaying needed follow-up care, risking adverse outcomes, or
requiring additional emergency care or hospitalization.”