Medical Specialists More Likely to Deny Treatment to Children on Medicaid

A new “secret shopper” study exploring Cook County clinics in Illinois revealed that children on Medicaid are much more likely than kids with private health insurance to be denied appointments with medical specialists. This study found

Children on Medicaid Less Likely to Receive Treatment

According to the study, which was reported in Thursday’s New England Journal of Medicine, a large number of children are likely to be denied treatment if they are on Medicaid. This finding was eerily similar to another in May that revealed dentists often deny treatment to children on Medicaid.

The research assistants in the study posed as mothers of sick children and called to make appointments for specialty care at 273 clinics one month apart. In one call, the researchers told the clinic they had public insurance and in the other, they said they had private coverage.

The study found the following to be true of the fictitious patients with public coverage:

  • Two-thirds were denied appointments, compared with 11 percent of privately insured patients.
  • In 89 clinics that accepted by public and private insurance, children on Medicaid were forced to wait an average of 22 days longer than those under private insurance for an appointment with a specialist.

Also, in more than 50 percent of the phone calls, the research assistant was asked what kind of insurance their child had before an appointment could be scheduled.

Why the Difference in Treatment?

As with the findings in the dentist study, the researchers determined a number of factors contributed to medical specialists not wanting to work with Medicaid patients:

  • Low reimbursement rates
  • Payment delays
  • Hassles associated with the payment process

Despite having legitimate reasons for feeling frustrated with the public insurance system, children could suffer as a result of having a much harder time gaining access to specialty care.

The study found this to be true with fictitious patients who had more serious conditions. The study included patients with seizure issues, severe depression and uncontrolled asthma. In each case, the children were denied treatment due to public insurance.

The researchers suggested the health care industry work harder to strengthen the primary care infrastructure so that referrals to specialists help children on public insurance receive treatment. Also, they recommended restructuring the payment system so that doctors will have the incentive necessary to see patients in need.