Wiznia Daniel H, Ndon Sifon, Kim Chang-Yeon, Zaki Theodore, Leslie Michael P
Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, New Haven, CT, USA.
Geriatr Orthop Surg Rehabil. 2017 Mar;8(1):23-29. doi: 10.1177/2151458516681635. Epub 2016 Dec 17.
To assess the effect of insurance type (Medicaid, Medicare, and private insurance) on fragility fracture patients' access to endocrinology specialists in the postoperative period.
The research team called 247 board-certified endocrinologists in 8 representative states. The caller requested an appointment for her fictitious mother to be evaluated for osteoporosis after suffering a hip fracture that required surgery. The caller stated that her mother had an abnormal level of parathyroid hormone and her mother's orthopedic surgeon believed she needed to see an endocrinologist. Each office was called 3 times to assess the responses for each insurance type. For each call, we documented whether the patient was able to receive an appointment and the barriers the patient confronted to receiving an appointment.
About 15.8% of offices scheduled an appointment for a patient with Medicaid, compared to 48.6% for Medicare and 54.3% for BlueCross ( < .0001). Medicaid patients confronted more barriers to receiving appointments. There was no statistically significant difference in access for Medicaid patients in states that had expanded Medicaid versus states that had not expanded Medicaid. Medicaid reimbursement for a new level 3 patient visit did not significantly correlate with appointment success rates or wait times.
Despite the passage of the Affordable Care Act, Medicaid patients have reduced access to endocrinologists and more complex barriers to receiving appointments. A more robust strategy for increasing access to care for Medicaid patients would be more equitable.
评估保险类型（医疗补助、医疗保险和私人保险）对脆性骨折患者术后看内分泌专科医生机会的影响。
研究团队致电8个代表性州的247名获得委员会认证的内分泌科医生。打电话者为她虚构的母亲预约就诊，其母亲因髋部骨折接受手术后需要评估骨质疏松情况。打电话者称她母亲甲状旁腺激素水平异常，其骨科医生认为她需要看内分泌科医生。每个诊所被致电3次，以评估每种保险类型的回复。每次致电，我们记录患者是否能获得预约以及患者在获得预约时面临的障碍。
约15.8%的诊所为医疗补助患者安排了预约，相比之下，医疗保险患者为48.6%，蓝十字保险患者为54.3%（P<0.0001）。医疗补助患者在获得预约方面面临更多障碍。在扩大了医疗补助的州和未扩大医疗补助的州，医疗补助患者在就诊机会上没有统计学显著差异。新的三级患者就诊的医疗补助报销与预约成功率或等待时间没有显著相关性。
尽管通过了《平价医疗法案》，医疗补助患者看内分泌科医生的机会减少，且在获得预约方面面临更复杂的障碍。制定一个更强有力增加医疗补助患者就医机会的策略会更公平。
