1. Primary Care Access to New Patient Appointments for California Medicaid Enrollees: A Simulated Patient Study.
- Author
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Melnikow J, Evans E, Xing G, Durbin S, Ritley D, Daniels B, and Woodworth L
- Subjects
- Adult, California, Child, Preschool, Female, Health Services Accessibility legislation & jurisprudence, Humans, Male, Medicaid legislation & jurisprudence, Patient Protection and Affordable Care Act, Patient Simulation, Primary Health Care legislation & jurisprudence, United States, Appointments and Schedules, Health Services Accessibility statistics & numerical data, Medicaid statistics & numerical data, Primary Health Care statistics & numerical data
- Abstract
Purpose: We 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., Methods: We 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., Results: Availability 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., Conclusions: In 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., (© 2020 Annals of Family Medicine, Inc.)
- Published
- 2020
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