Wiznia Daniel H, Maisano Julianna, Kim Chang-Yeon, Zaki Theodore, Lee Hochang B, Leslie Michael P
Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 800 Howard Ave, New Haven, CT 06510, United States.
Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 800 Howard Ave, New Haven, CT 06510, United States.
Gen Hosp Psychiatry. 2017 Mar-Apr;45:19-24. doi: 10.1016/j.genhosppsych.2016.12.006. Epub 2016 Dec 18.
The objective of the study was to assess the effect of insurance type (Medicaid, Medicare, private insurance or cash pay) on patients' access to psychiatrists for a new patient consultation.
240 psychiatrists identified as interested in treating patients with PTSD were called across 8 states. The caller requested an appointment for her fictitious boyfriend who had been in a car accident to be evaluated for PTSD. Each office was called four times to assess the responses for each payment type. From each call, whether an appointment was offered and barriers to an appointment were recorded.
21% of psychiatrists would see new patients. 15% of offices scheduled an appointment for a patient with Medicaid, compared to 34% for Medicare, 54% for BlueCross and 93% for cash pay (p<0.001). Medicaid patients confronted more barriers to receiving appointments and had more trouble scheduling appointments in states with expanded Medicaid eligibility. The overall number of Medicaid patients who would be able to theoretically schedule an appointment in states with versus states without expanded Medicaid eligibility was approximately equivalent. Psychiatry practice characteristics, such as whether the practice was academic, were not significantly associated with acceptance of Medicaid.
Access to a psychiatrist for a new patient consultation is challenging. Despite expansion of the Affordable Care Act, substantial barriers remain for Medicaid patients in accessing psychiatric care compared to patients with Medicare, private insurance or those who pay cash.
本研究的目的是评估保险类型（医疗补助、医疗保险、私人保险或现金支付）对患者获得精神科医生进行新患者咨询的影响。
在8个州致电240名确定有兴趣治疗创伤后应激障碍患者的精神科医生。打电话者为她虚构的在车祸中受伤的男朋友预约，以评估其是否患有创伤后应激障碍。每个办公室被呼叫4次，以评估每种支付类型的回应。每次通话都记录是否提供预约以及预约的障碍。
21%的精神科医生愿意接待新患者。15%的办公室为医疗补助患者安排了预约，相比之下，医疗保险患者为34%，蓝十字保险患者为54%，现金支付患者为93%（p<0.001）。医疗补助患者在获得预约方面面临更多障碍，并且在医疗补助资格扩大的州安排预约更困难。在医疗补助资格扩大的州与未扩大的州，理论上能够安排预约的医疗补助患者总数大致相当。精神科的执业特征，如是否为学术性执业，与接受医疗补助没有显著关联。
新患者获得精神科医生咨询具有挑战性。尽管《平价医疗法案》有所扩大，但与医疗保险患者、私人保险患者或现金支付患者相比，医疗补助患者在获得精神科护理方面仍然存在重大障碍。
