Specialty MDs turn away most children with public insurance

Sixty-six percent of publicly-insured children were unable to get a doctor’s appointment for medical conditions requiring outpatient specialty care including diabetes and seizures, while children with identical symptoms and private insurance were turned away only 11 percent of the time, according to an audit study of specialty physician practices in Cook County, IL.

“We found disturbing disparities in specialty physicians’ willingness to provide outpatient care for children with public insurance — even those with urgent and severe health problems. This study shows a failure to care for our most vulnerable children” said a study author.

Reimbursement amounts, incentives, and the mission of the health care provider are major factors, with reimbursements being key. It takes a long time for the government to pay and it often doesn’t pay as much as private insurance, plus the paperwork can be onerous.

Many doctors now are getting squeezed by insurance companies and the government. I know of one MD who despite his best efforts to manage insurance and having one employee who did it full time, was recently forced to join a group practice where they have several people who do nothing but insurance. A while back, my obstetrician cousin shut down her practice when her malpractice insurance jumped from $60,000 to $200,000 a year.

Our medical system is broken. Private insurance is difficult enough for doctors to manage. Public insurance is even worse and it pays less. Thus it’s no surprise, if disheartening, that MDs don’t want to take public insurance patients. There may be a class issue here too. If a child is on public insurance then the parents are probably on welfare and doctors may not want to deal with them. What a mess.

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