Blog | Friday, March 16, 2012

QD: News Every Day--Medicaid patients face twice as many barriers to primary care


Twice as many Medicaid patients report barriers to primary care and use the emergency department twice as often as their privately insured peers, according to a study.

That Medicaid patients visit the ER more, because of poorer health or because they can't see their primary care provider in a timely fashion, isn't surprising. The study puts some numbers to the trend compared to privately insured people.

The study analyzed 230,238 adults from the 1999-2009 National Health Interview Survey. Results appeared in Annals of Emergency Medicine.

Overall, 16.3% of Medicaid and 8.9% of private insurance beneficiaries had one or more barriers to timely primary care. Among the barriers, the largest differences were "no transportation" (7.6% versus 0.6%), "waited too long in physician's office" (7.6% versus 3.6%), and "couldn't get an appointment soon enough" (7.2% versus 5.2%).

Compared with individuals with private insurance, Medicaid beneficiaries had higher emergency department use overall (39.6% versus 17.7%), particularly among those with barriers (51.3% versus 24.6% for one barrier and 61.2% versus 28.9% for two or more). After adjusting for covariates, Medicaid beneficiaries were more likely to have barriers (adjusted odds ratio [OR], 1.41; 95% confidence interval [CI] 1.30 to 1.52) and higher emergency department use (adjusted OR, 1.48; 95% CI, 1.41 to 1.56).

Barriers to care were associated with increased emergency department use among Medicaid patients and the privately insured. However, the same number of barriers was associated with higher odds of emergency department use among the Medicaid beneficiaries compared with those privately insured. It was even higher among Medicaid beneficiaries with one barrier (adjusted OR, 1.66; 95% CI, 1.44 to 1.92) or two or more barriers (adjusted OR, 2.01; 95% CI, 1.72 to 2.35) compared to individuals with private insurance and barriers.

"[U]nless there is improved primary care availability and access, the [emergency department] will continue to serve as an increasingly important venue for acute care of Medicaid beneficiaries," the authors concluded.