Yale School of Medicine, Section of General Surgery, Trauma, and Surgical Critical Care.
Yale School of Medicine, Section of General Surgery, Trauma, and Surgical Critical Care.
Surgery. 2018 Aug;164(2):201-205. doi: 10.1016/j.surg.2018.03.013. Epub 2018 May 8.
The expansion of Medicaid under the Affordable Care Act extended coverage to any individual with an income up to 138% of the federal poverty level. Our study of surgeon practice management investigated the impact of the type of insurance on access to elective inguinal hernia repair and the disparities in access between Medicaid expansion and nonexpansion states.
Practices of 240 hernia repair surgeons across 8 states were randomly selected from the American College of Surgeons Find a Surgeon Database. Investigators posed as simulated patients seeking an evaluation for an inguinal hernia. Physician offices were contacted using a standardized script on separate occasions to assess appointment success rates and waiting periods for 3 different insurance types (BlueCross, Medicaid, Medicare).
Of 240 surgical practices contacted, 75.4% scheduled appointments for Medicaid patients, compared to 98.8% for Medicare patients and 98.3% for those with private insurance. In states that expanded Medicaid, fewer offices accepted Medicaid patients compared to those in nonexpanded states. No differences in wait times between expanded and nonexpanded states were observed. Surgeons in either solo practices or urban settings were less likely to accept Medicaid patients than those in either group practices or non-urban offices.
Simulated Medicaid patients were less successful at scheduling appointments for surgical consultation than BlueCross or Medicare patients. Fewer surgical practices in expansion states accepted Medicaid patients despite increased coverage due to Medicaid expansion. These findings should be further investigated amidst future changes in Medicaid to understand their impact on access to surgical care.
平价医疗法案扩大了医疗补助计划的覆盖范围，将收入在联邦贫困线 138%以下的所有人都纳入了保障范围。我们对外科医生实践管理的研究调查了保险类型对选择性腹股沟疝修补术可及性的影响，以及在医疗补助计划扩张和不扩张的州之间可及性的差异。
从美国外科医师学会的“寻找外科医生”数据库中随机选择了 8 个州的 240 名疝修补外科医生的实践。调查人员以模拟患者的身份提出了一个评估腹股沟疝的问题。使用标准化脚本在不同时间联系医生办公室，以评估 3 种不同保险类型（BlueCross、Medicaid、Medicare）的预约成功率和等待期。
在联系的 240 个外科实践中，有 75.4%为 Medicaid 患者安排了预约，而 Medicare 患者的预约成功率为 98.8%，私人保险患者的预约成功率为 98.3%。在扩大 Medicaid 的州，与未扩大 Medicaid 的州相比，接受 Medicaid 患者的办公室较少。在扩大和不扩大 Medicaid 的州之间，没有观察到等待时间的差异。在个体执业或城市环境中的外科医生比在团体执业或非城市办公室中的外科医生更不可能接受 Medicaid 患者。
模拟 Medicaid 患者在预约手术咨询方面比 BlueCross 或 Medicare 患者更不成功。尽管由于 Medicaid 扩张而增加了覆盖范围，但扩张州的外科医生实践中接受 Medicaid 患者的人数较少。在 Medicaid 未来发生变化的情况下，应进一步调查这些发现，以了解它们对获得手术护理的影响。
