Medicaid Patients Have Greater Difficulty Scheduling Health Care Appointments Compared With Private Insurance Patients: A Meta-Analysis
Medicaid Patients Have Greater Difficulty Scheduling Health Care Appointments Compared With Private Insurance Patients: A Meta-Analysis
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DOI：
10.1177/0046958019838118
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发表时间：
2019-04-05
影响因子：
1.7
通讯作者：
Wiznia, Daniel H.
中科院分区：
文献类型：
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作者：
Hsiang, Walter R.;Lukasiewicz, Adam;Wiznia, Daniel H.
众所周知，与私人保险患者相比，医疗补助患者获得护理的机会较少；然而，用大型对照研究来量化这种差异仍然是一个挑战。本荟萃分析通过对医疗保健预约和时间表的审计研究来评估医疗补助和私人保险患者在医疗服务可及性方面的差异。审计研究评估不同类型的门诊医生的做法被选择。根据模拟患者情景的特征对研究进行分类。针对所有不同类型的审计场景特征，计算了预约可用性的相对风险。作为第二项分析，我们比较了医疗补助扩张前后的预约情况。总体而言，确定了34项审计研究，这些研究表明，与私人保险相比，医疗补助保险与成功安排初级保健预约的可能性降低了1.6倍，成功安排专科预约的可能性降低了3.3倍。在第一个荟萃分析中，比较了医疗补助和私人保险患者的预约情况，我们证明在各种医疗情况下，医疗补助患者比私人保险患者更难获得预约。
Medicaid patients are known to have reduced access to care compared with privately insured patients; however, quantifying this disparity with large controlled studies remains a challenge. This meta-analysis evaluates the disparity in health services accessibility of appointments between Medicaid and privately insured patients through audit studies of health care appointments and schedules. Audit studies evaluating different types of outpatient physician practices were selected. Studies were categorized based on the characteristics of the simulated patient scenario. The relative risk of appointment availability was calculated for all different types of audit scenario characteristics. As a secondary analysis, appointment availability was compared pre- versus post-Medicaid expansion. Overall, 34 audit studies were identified, which demonstrated that Medicaid insurance is associated with a 1.6-fold lower likelihood in successfully scheduling a primary care appointment and a 3.3-fold lower likelihood in successfully scheduling a specialty appointment when compared with private insurance. In this first meta-analysis comparing appointment availability between Medicaid and privately insured patients, we demonstrate Medicaid patients have greater difficulty obtaining appointments compared with privately insured patients across a variety of medical scenarios.