1. Primary Care Access to New Patient Appointments for California Medicaid Enrollees: A Simulated Patient Study
- Author
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Melnikow, Joy, Evans, Ethan, Xing, Guibo, Durbin, Shauna, Ritley, Dominique, Daniels, Brock, and Woodworth, Lindsey
- Subjects
Health Services and Systems ,Health Sciences ,Health Services ,Clinical Research ,Good Health and Well Being ,Adult ,Appointments and Schedules ,California ,Child ,Preschool ,Female ,Health Services Accessibility ,Humans ,Male ,Medicaid ,Patient Protection and Affordable Care Act ,Patient Simulation ,Primary Health Care ,United States ,insurance ,health ,Medicaid expansion ,national health insurance ,health services accessibility ,vulnerable populations ,primary care access ,barriers ,simulated patient ,secret shopper ,practice-based research ,health ,insurance ,Medical and Health Sciences ,Studies in Human Society ,General & Internal Medicine ,Biomedical and clinical sciences ,Health sciences ,Human society - Abstract
PurposeWe undertook a study to evaluate variation in the availability of primary care new patient appointments for Medi-Cal (California Medicaid) enrollees in Northern California, and its relationship to emergency department (ED) use after Medicaid expansion.MethodsWe placed simulated calls by purported Medi-Cal enrollees to 581 primary care clinicians (PCCs) listed as accepting new patients in online directories of Medi-Cal managed care plans. Data from the California Health Interview Survey, Medi-Cal enrollment reports, and California hospital discharge records were used in analyses. We developed multilevel, mixed-effect models to evaluate variation in appointment access. Multiple linear regression was used to examine the relationship between primary care access and ED use by county.ResultsAvailability of PCC new patient appointments to Medi-Cal enrollees lacking a PCC varied significantly across counties in the multilevel model, ranging from 77 enrollees (95% CI, 70-81) to 472 enrollees (95% CI, 378-628) per each available new patient appointment. Just 19% of PCCs had available appointments within the state-mandated 10 business days. Clinicians at Federally Qualified Health Centers had higher availability of new patient appointments (rate ratio = 1.56; 95% CI, 1.24-1.97). Counties with poorer PCC access had higher ED use by Medi-Cal enrollees.ConclusionsIn contrast to findings from other states, access to primary care in Northern California was limited for new patient Medi-Cal enrollees and varied across counties, despite standard statewide reimbursement rates. Counties with more limited access to primary care new patient appointments had higher ED use by Medi-Cal enrollees.
- Published
- 2020