Skaggs D L, Clemens S M, Vitale M G, Femino J D, Kay R M
Childrens Hospital Los Angeles, University of Southern California, Keck School of Medicine, Los Angeles, California, USA.
Pediatrics. 2001 Jun;107(6):1405-8. doi: 10.1542/peds.107.6.1405.
To compare the availability of timely orthopedic care to a child with a fractured arm insured by Medi-Cal (California state Medicaid) and by private insurance.
Fifty randomly chosen offices of orthopedic surgeons were telephoned with the following scenario: "My 10-year-old son broke his arm last week during a vacation" followed by a request for an appointment that week. Each office was called twice with an identical script except for insurance status: once with Medi-Cal and once with private insurance.
All 50 offices offered an appointment to see the child with private insurance within 7 days. Only 1 of the same 50 offices offered an appointment to see the child with Medi-Cal within 7 days. Of the offices that would not see a child with Medi-Cal, 87% were unable to recommend an orthopedic office that accepted Medi-Cal.
Timely access to orthopedic care was available in 100% of offices polled to a child with private insurance versus in 2% of offices to a child with Medi-Cal. This is a significant difference. Lack of timely orthopedic care may result in poor outcome, ie, if a fracture is not properly aligned in the first few weeks, a permanent deformity may result. Although causation cannot be established from this study, we suspect that Medi-Cal reimbursement rates below the cost of office overhead may be of significance. Although federal guidelines require that payments must be sufficient to enlist enough providers so that services to Medi-Cal recipients are available to the same extent as those available to the general population, this study finds that that children with Medi-Cal insurance have significantly less access to timely orthopedic care.
比较为一名手臂骨折的儿童提供及时骨科护理的可及性，该儿童分别参保了加州医疗补助计划（加利福尼亚州医疗补助）和私人保险。
随机拨打50家骨科外科医生办公室电话，描述如下情景：“我10岁的儿子上周在度假时手臂骨折了”，随后请求在当周预约就诊。除保险状态外，每个办公室都用相同的话术拨打两次电话：一次提及参保加州医疗补助计划，一次提及参保私人保险。
所有50家办公室都为参保私人保险的儿童提供了7天内的预约就诊。同样的50家办公室中只有1家为参保加州医疗补助计划的儿童提供了7天内的预约就诊。在那些不接收参保加州医疗补助计划儿童的办公室中，87%无法推荐一家接受加州医疗补助计划的骨科办公室。
在接受调查的办公室中，100%为参保私人保险的儿童提供了及时的骨科护理，而只有2%为参保加州医疗补助计划的儿童提供了及时的骨科护理。这是一个显著差异。缺乏及时的骨科护理可能会导致不良后果，例如，如果骨折在最初几周没有正确复位，可能会导致永久性畸形。尽管本研究无法确定因果关系，但我们怀疑加州医疗补助计划的报销率低于办公室运营成本可能是一个重要因素。尽管联邦指导方针要求支付的费用必须足以吸引足够的医疗服务提供者，以便为加州医疗补助计划受益人与普通人群提供同等程度的服务，但本研究发现，参保加州医疗补助计划的儿童获得及时骨科护理的机会明显更少。
