Wait times for Medicaid patients creep up slightly, timely appointments still generally accessible, JAMA study says

More than 14 million adults have enrolled in Medicaid since the health law passed, and that has caused some hand-wringing over whether there would be enough primary care providers to meet the demand. But a study out this week suggests that the newly insured people are generally able to get timely appointments for primary care.

For the study, which was published online in JAMA Internal Medicine, trained field workers posing as new Medicaid or privately insured patients called physician practices in 10 states and requested a new-patient appointment for either a checkup or newly diagnosed high blood pressure. They recorded whether they were able to get an appointment and how soon it could be scheduled.

The states in the study -- Arkansas, Georgia, Illinois, Iowa, Massachusetts, Montana, New Jersey, Oregon, Pennsylvania and Texas -- represented a mix of states that expanded Medicaid coverage to adults with incomes up to 138 percent of the federal poverty level (about $16,600) and those that haven't done so. An initial round of fieldworker calls to more than 9,700 practices was made in 2012 and 2013, before most states had expanded Medicaid coverage, followed by a second round of calls to more than 7,300 practices in 2016.

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Over the time periods studied, appointment availability improved for Medicaid callers by 5.4 percentage points, while it stayed stable for privately insured callers (though Medicaid callers still had a tougher time getting appointments in general).

But, during the second study period, callers from both groups were less likely to be able to schedule an appointment within a week. The proportion of Medicaid callers who waited a week or less decreased by 6.7 percentage points, to 49.1 percent; the share of those who said they were privately insured who waited a week or less declined by 4.1 percentage points, to 52.7 percent.

"Some of these offices were getting a little more full," said Daniel Polsky, executive director of the Leonard Davis Institute of Health Economics at the University of Pennsylvania and the study's lead author. "One way doctors were making room for more patients was that instead of making an appointment in a week's time, some were making it in two weeks."

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There are many factors that may have contributed to the ability of primary care providers to absorb more patients, including increased funding for federally qualified health centers and the growth of retail clinics, among others.

The study should ease concerns that the health law will exacerbate the shortage of primary care providers, Polsky said, though there may still be regional challenges accessing care.

"It's still true that fewer doctors are willing to see Medicaid patients than are willing to see commercial patients," he said. "But if you have Medicaid, your access to doctors is still good."

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