An undercover survey done in Illinois reveals that doctors are resistant to provide outpatient care for children who are covered by Medicaid Children’s Health Insurance Program (CHIP). The survey’s results match a previous one that found that Illinois dentists were also unwilling to take children who used CHIP. The reasons why may have something to do with how physicians are reimbursed in Illinois.
Medicaid is a federal run health insurance program designed to be used by people who have low incomes. The Medicaid Children’s Health Insurance Program is, obviously, designed to cover children whose parent’s don’t make enough money to be able to afford private health insurance that would provide coverage for their children. In other words, the people using Medicaid are doing so because they truly do not have any other options.
Not too long ago, results of a study that was done in Illinois revealed that dentists were very hesitant about making appointments for children who were covered by Medicaid, even if those children had a serious dental issue. A group of women posed as moms of a (fictitious) child who had fractured his front tooth. They asked for a dentist appointment.
When the “moms” said that their son was covered by Blue Cross, (a private insurance company), almost 95% of them were given a dental appointment for their child. Only 68% of the “moms” who said that their son was covered by Medicaid got dental appointments. Dental offices that were not enrolled with Medicaid only offered 7% of those “moms” appointments.
Now, a study that was published in The New England Journal of Medicine reveals that doctors in Illinois are also resistant to treating children who are covered by Medicaid (or CHIP). Researchers again posed as moms, and called 273 specialists located in Cook County, Illinois.
The “moms” asked for a doctor’s appointment for their (nonexistent) child, who they said was experiencing uncontrolled asthma, a seizure, severe depression, or some other serious health issue. When the “moms” said their child was covered by Blue Cross and Blue Shield health insurance, only 10% were turned away. But, out of the “moms” who said that their child was covered by the Medicaid program, 65.6% were not given doctor’s appointments.
The study also found that orthopedists and psychiatrists turned away children who were Medicaid patients more than 80% of the time. The “moms” who said that their child was suffering from epilepsy, and who was covered by Medicaid, only had a 46% chance of seeing a neurologist. The study also noted that the doctors who did give children covered by Medicaid an appointment made them wait 22 days later (on average) than children who were covered by private health insurance.
The reason this is happening could be due to how the state of Illinois reimburses its doctors. For an average office visit in Illinois, a private insurance company would be paying the doctor $160.00. The Medicaid-CHIP program only pays doctors around $99.36 (on average).
Image by Carl Wuerz on Flickr