Access to primary care appointments varies by insurance status

Individuals posing as patients covered by private insurance were more likely to secure a new-patient appointment with a primary care physician compared to individuals posing as patients covered by Medicaid or uninsured.

The Patient Protection and Affordable Care Act (ACA) expands insurance access, which is intended to improve access to care for the newly insured. But it is unknown whether the primary care system can handle the increased demand.

The authors sought to estimate a baseline for primary care access before the ACA coverage expansions took effect in January 2014. Trained field staff called primary care offices in Arkansas, Georgia, Illinois, Iowa, Massachusetts, Montana, New Jersey, Oregon, Pennsylvania and Texas to ask about making a new patient appointment between November 2012 and April 2013. The callers posed as nonelderly adults with either private insurance, Medicaid or no insurance. A total of 12,907 calls were made to 7,788 primary care practices between November 2012 and April 2013.

Across the 10 states, 84.7 percent of the callers who said they had private insurance were able to get an appointment, as were 57.9 percent of callers claiming to have Medicaid coverage. Appointment rates were 78.8 percent for uninsured patients offering full cash payment but only 15.4 percent if the payment required at the time of the visit was $75 or less. Median (midpoint) wait times ranged from between five and eight days for private and Medicaid callers. About 75 percent of callers in both those patient groups were able to get a new-patient appointment in less than 2 weeks.

"Although most primary care physicians are accepting new patients, access varies widely across states and insurance status. … Tracking new patient appointment availability over time can inform policies designed to strengthen primary care capacity and enhance the effectiveness of the coverage expansions with the Patient Protection and Affordable Care Act."

Author: Karin V. Rhodes, M.D., M.S., of the University of Pennsylvania Perelman School of Medicine, Philadelphia, and colleagues.

(JAMA Intern Med. Published online April 7, 2014. doi:10.1001/jamainternmed.2014.20. Available pre-embargo to the media at http://media.jamanetwork.com.)

Editor's Note: This work was supported by the Robert Wood Johnson Foundation. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

In a related commentary, Andrew B. Bindman, M.D., and Janet M. Coffman, Ph.D., of the University of California, San Francisco, write: "Although the findings of Rhodes et al and those of physician surveys suggest that a smaller proportion of physicians care for Medicaid beneficiaries than for patients with private insurance coverage, the medical needs of the Medicaid population could still be adequately met if participating practices were conveniently located near where Medicaid beneficiaries live and if they served enough Medicaid patients. However, study findings suggest not only that physician participation in Medicaid is low but also that those who do participate care on average for a small number of Medicaid beneficiaries."

'There is little indication as to whether primary care practitioners will meet the access challenges associated with implementing Medicaid expansion as part of the ACA," they continue.

"Timely monitoring of physician participation in Medicaid and the number of Medicaid patients in participating practices could inform federal and state policy makers regarding the need to extend and potentially expand payment policy incentives and other reforms to ensure adequate access to care for the expanding population of Medicaid beneficiaries," they conclude.

(JAMA Intern Med. Published online April 7, 2014. doi:10.1001/jamainternmed.2013.13421. Available pre-embargo to the media at http://media.jamanetwork.com.)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Media Advisory: To contact author Karin V. Rhodes, M.D., M.S., call Jessica Mikulski at 215-349-8369 or email Jessica.Mikulski@uphs.upenn.edu. To contact commentary author Andrew B. Bindman, M.D., call Karin Rush-Monroe at 415-502-6397 or email Karin.Rush-Monroe@ucsf.edu.