FREE NEJM E-TOC    HOME   |   SUBSCRIBE   |   CURRENT ISSUE   |   PAST ISSUES   |   COLLECTIONS   |   Search Term  Advanced Search

Sign in | Get NEJM's E-Mail Table of Contents — Free | Subscribe

Previous Volume 330:1426-1430 May 19, 1994 Number 20 Next

	Full Text Letters Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Visits to the emergency department by Medicaid recipients for nonemergency problems are common and contribute to rising health care costs. However, such patients may have few alternatives. We conducted a telephone survey of 953 ambulatory care sites in 10 cities to determine the availability of appointments for Medicaid recipients with common problems.

Methods Research assistants telephoned all ambulatory care clinics and a stratified sample of private primary care practices in the catchment area served by the hospital emergency department in each city. The assistants identified themselves as Medicaid recipients seeking care for one of three problems (low back pain, dysuria, or sore throat) and asked a standardized series of questions. Data were collected on appointments or walk-in visits authorized at any time, within two days after the call, or after 5 p.m.; copayment requirements; and reasons appointments could not be made. If an appointment was made, it was canceled at the end of each call or shortly thereafter. Several weeks later, private-practice sites in six of the cities were recontacted; the research assistants identified themselves as patients with private insurance and the same problem.

Results An appointment or an authorization for a walk-in visit was obtained from 418 of the 953 practice sites (44 percent); 47 of the sites (5 percent) could not be contacted. Appointment rates for the different types of sites ranged from 72 percent for free-standing urgent care centers to 34 percent for private practices. "Not accepting Medicaid" was the most common reason given for not granting an appointment or walk-in visit. Only 72 of the sites (8 percent) offered after-hours care within two working days after the call without a cash copayment. Sixty percent of the 330 private practices that were recontacted agreed to see a patient with private insurance within two working days, but only 26 percent agreed to see a patient with Medicaid within two days (P<0.001).

Conclusions Medicaid recipients in urban areas have limited access to outpatient care apart from that offered by hospital emergency departments.

Source Information

Dr. Kellermann, as the chairman of the study, assumes full responsibility for the overall content and integrity of the manuscript.The members of the Medicaid Access Study Group are as follows: University of Tennessee, Memphis -- A.L. Kellermann, C. Conway, R. Wolcott, B.B. Hackman, and S. Bogan; Boston University, Boston -- E. Bernstein, S. Fish, and T. Kerl; University of South Florida, Tampa -- T. Mitchell and C. Ramsey; Johns Hopkins University, Baltimore -- G.D. Kelen and J.B. Shahan; New York Medical College, Bronx, New York -- H. Osborn and L. Bazan; Medical College of Wisconsin, Milwaukee -- S. Hargarten and S. Laurence; Oregon Health Sciences University, Portland -- J.R. Hedges, G. Henkel, S. Winter, and A. Yekrang; Texas Tech University, El Paso -- L. Binder, B. Kempton, and D. Harriman; University of California, Davis, Sacramento -- G. Wintemute and H. Smith; and Wright State University, Dayton, Ohio -- G. Hamilton and L. Morris.

Address reprint requests to Dr. Arthur L. Kellermann at the Division of Emergency Medicine, Department of Surgery, Emory University School of Medicine, 1462 Clifton Rd., N.E., Atlanta, GA 30322.

Full Text of this Article

Related Letters:

Access of Medicaid Recipients to Outpatient Care
Derlet R. W., Kinser D., Bessinger C.D., Pollock S. G., Pipas J.E., Kellermann A. L., Wintemute G., Binder L.
Extract | Full Text  
N Engl J Med 1994; 331:877-878, Sep 29, 1994. Correspondence

Costs of Visits to Emergency Departments
Baier C. L., Auerbach S. B., Becker K. A., Hearst N., Lucey C., Williams R. M.
Extract | Full Text  
N Engl J Med 1996; 335:209-211, Jul 18, 1996. Correspondence

This article has been cited by other articles:

• Brousseau, D. C., Hoffmann, R. G., Nattinger, A. B., Flores, G., Zhang, Y., Gorelick, M. (2007). Quality of Primary Care and Subsequent Pediatric Emergency Department Utilization. Pediatrics 119: 1131-1138 [Abstract] [Full Text]  
• Fremont, A. M., Young, A. S., Chinman, M., Pantoja, P., Morton, S., Koegel, P., Sullivan, G., Kanouse, D. (2007). Differences in HIV Care Between Patients With and Without Severe Mental Illness. Psychiatr. Serv. 58: 681-688 [Abstract] [Full Text]  
• Cabana, M., Slish, K. K., Nan, B., Leo, H., Bratton, S. L., Dombkowski, K. J. (2006). Outcomes Associated With Spirometry for Pediatric Asthma in a Managed Care Organization. Pediatrics 118: e151-e156 [Abstract] [Full Text]  
• Kattan, M., Crain, E. F., Steinbach, S., Visness, C. M., Walter, M., Stout, J. W., Evans, R. III, Smartt, E., Gruchalla, R. S., Morgan, W. J., O'Connor, G. T., Mitchell, H. E. (2006). A randomized clinical trial of clinician feedback to improve quality of care for inner-city children with asthma.. Pediatrics 117: e1095-e1103 [Abstract] [Full Text]  
• Galbraith, A. A., Grossman, D. C., Koepsell, T. D., Heagerty, P. J., Christakis, D. A. (2005). Medicaid Acceptance and Availability of Timely Follow-up for Newborns With Medicaid. Pediatrics 116: 1148-1154 [Abstract] [Full Text]  
• Asplin, B. R., Rhodes, K. V., Levy, H., Lurie, N., Crain, A. L., Carlin, B. P., Kellermann, A. L. (2005). Insurance Status and Access to Urgent Ambulatory Care Follow-up Appointments. JAMA 294: 1248-1254 [Abstract] [Full Text]  
• Cabana, M. D., Slish, K. K., Nan, B., Lin, X., Clark, N. M. (2005). Asking the Correct Questions to Assess Asthma Symptoms. CLIN PEDIATR 44: 319-325 [Abstract]  
• Hakim, R. B., Benedict, M. B., Merrick, N. J. (2004). Quality of Care for Women Undergoing a Hysterectomy: Effects of Insurance and Race/Ethnicity. Am. J. Public Health 94: 1399-1405 [Abstract] [Full Text]  
• Moore, P. J., Sickel, A. E., Malat, J., Williams, D., Jackson, J., Adler, N. E. (2004). Psychosocial Factors in Medical and Psychological Treatment Avoidance: The Role of the Doctor-Patient Relationship. J Health Psychol 9: 421-433 [Abstract]  
• Mulla, Z. D., Margo, C. E. (2004). Hospitalization for Nontraumatic Disorders of the Eye and Ocular Adnexa: Analysis of the Florida Agency for Health Care Administration Data Set. Arch Ophthalmol 122: 262-266 [Abstract] [Full Text]  
• Kellermann, A. L. (2003). Deferred Care for Emergency Department Users with Nonacute Conditions. ANN INTERN MED 139: 526-528 [Full Text]  
• The Physicians' Working Group for Single-Payer Nat, (2003). Proposal of the Physicians' Working Group for Single-Payer National Health Insurance. JAMA 290: 798-805 [Abstract] [Full Text]  
• Kotagal, U. R., Schoettker, P. J., Atherton, H. D., Hornung, R. W., Bush, D., Pomerantz, W. J., Schubert, C. J. (2002). Relationship Between Early Primary Care and Emergency Department Use in Early Infancy by the Medicaid Population. Arch Pediatr Adolesc Med 156: 710-716 [Abstract] [Full Text]  
• Kushel, M. B., Perry, S., Bangsberg, D., Clark, R., Moss, A. R (2002). Emergency Department Use Among the Homeless and Marginally Housed: Results From a Community-Based Study. Am. J. Public Health 92: 778-784 [Abstract] [Full Text]  
• Forrest, C. B., Whelan, E.-M. (2000). Primary Care Safety-Net Delivery Sites in the United States: A Comparison of Community Health Centers, Hospital Outpatient Departments, and Physicians' Offices. JAMA 284: 2077-2083 [Abstract] [Full Text]  
• Piehl, M. D., Clemens, C. J., Joines, J. D. (2000). "Narrowing the Gap": Decreasing Emergency Department Use by Children Enrolled in the Medicaid Program by Improving Access to Primary Care. Arch Pediatr Adolesc Med 154: 791-795 [Abstract] [Full Text]  
• Kotagal, U. R., Atherton, H. D., Eshett, R., Schoettker, P. J., Perlstein, P. H. (1999). Safety of Early Discharge for Medicaid Newborns. JAMA 282: 1150-1156 [Abstract] [Full Text]  
• Sullivan, G., Koegel, P., Kanouse, D. E., Cournos, F., McKinnon, K., Young, A. S., Bean, D. (1999). HIV and People With Serious Mental Illness: The Public Sector's Role in Reducing HIV Risk and Improving Care. Psychiatr. Serv. 50: 648-652 [Abstract] [Full Text]  
• Berren, M. R., Santiago, J. M., Zent, M. R., Carbone, C. P. (1999). Health Care Utilization by Persons With Severe and Persistent Mental Illness. Psychiatr. Serv. 50: 559-561 [Abstract] [Full Text]  
• Morrison, R. S., Zayas, L. H., Mulvihill, M., Baskin, S. A., Meier, D. E. (1998). Barriers to Completion of Health Care Proxies: An Examination of Ethnic Differences. Arch Intern Med 158: 2493-2497 [Abstract] [Full Text]  
• Selby, J. V. (1997). Cost Sharing in the Emergency Department -- Is It Safe? is It Needed?. NEJM 336: 1750-1751 [Full Text]  
• Baier, C. L., Auerbach, S. B., Becker, K. A., Hearst, N., Lucey, C., Williams, R. M. (1996). Costs of Visits to Emergency Departments. NEJM 335: 209-211 [Full Text]  
• Williams, R. M. (1996). The Costs of Visits to Emergency Departments. NEJM 334: 642-646 [Abstract] [Full Text]  
• Steinbrook, R. (1996). The Role of the Emergency Department. NEJM 334: 657-658 [Full Text]  
• Goldberg, M. A., Marmor, T. R. (1995). The Relation between Universal Health Insurance and Cost Control. NEJM 332: 742-745 [Full Text]  
• Derlet, R. W., Kinser, D., Bessinger, C.D., Pollock, S. G., Pipas, J.E., Kellermann, A. L., Wintemute, G., Binder, L. (1994). Access of Medicaid Recipients to Outpatient Care. NEJM 331: 877-878 [Full Text]  
• Reinhardt, U. E. (1994). Coverage and Access in Health Care Reform. NEJM 330: 1452-1453 [Full Text]