Department of Orthopaedic Surgery, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, LA, USA.
Rutgers Robert Wood Johnson Medical School, Piscataway, NJ, USA.
J Natl Med Assoc. 2019 Apr;111(2):148-152. doi: 10.1016/j.jnma.2018.07.005. Epub 2018 Aug 11.
As of January 2017, 32 states have decided to expand Medicaid through the Patient Protection and Affordable Care Act. The uninsured rate in the United States has decreased, but does the increased coverage translate to increased access to outpatient orthopedic care? Through a simulated patient telephone survey, this study aims to evaluate access to orthopedic surgeons for Medicaid patients in Louisiana.
A comprehensive list of potentially eligible orthopedic surgeons in the state of Louisiana was obtained from an online public database managed by the Louisiana Medicaid website (lamedicaid.com). This list represented all orthopedic surgeons that received a Medicaid payment within the six months prior to February 1st, 2017 (August 1st, 2016-January 31st, 2017). Using an internet search, we found that 309 orthopedic surgeons listed met the inclusion criteria and were practicing in 93 different clinical practices. Because several orthopedists practiced in the same group practice, and some practiced in multiple practices, we sampled unique clinical practices as opposed to individual providers. One telephone call was made to each practice in an attempt to secure an appointment for a simulated Medicaid patient. The average number of orthopedic surgeons per practice was 3.4, with the majority of practices (60%) being private practices with only one surgeon.
Of the 93 practices in the study, only 17 (18.3%) offered an appointment. The 17 practices represented 41 orthopedic surgeons (13.3%) that were willing to accept new Medicaid patients. That number decreased to 22 (7.1%) if you remove the orthopedic surgeons practicing at safety-net facilities.
The results suggest that although Medicaid expansion has decreased the uninsured rate, access to outpatient orthopedic care for Medicaid patients in Louisiana is still significantly limited.
截至 2017 年 1 月，32 个州已决定通过《患者保护与平价医疗法案》扩大医疗补助计划。美国的未参保率有所下降，但增加的覆盖范围是否转化为更多获得门诊骨科护理的机会？通过模拟患者电话调查，本研究旨在评估路易斯安那州医疗补助患者获得骨科医生的机会。
从路易斯安那州医疗补助网站（lamedicaid.com）管理的在线公共数据库中获得该州所有符合条件的骨科医生的综合名单。该名单代表了在 2017 年 2 月 1 日之前的六个月内（2016 年 8 月 1 日-2017 年 1 月 31 日）收到医疗补助付款的所有骨科医生。通过互联网搜索，我们发现列出的 309 名骨科医生符合纳入标准，并在 93 个不同的临床实践中执业。由于一些骨科医生在同一家集团诊所执业，而一些医生在多个诊所执业，因此我们对每个实践进行了抽样，而不是对个人提供者进行抽样。每个实践尝试进行一次电话联系，以确保为模拟医疗补助患者预约。每个实践平均有 3.4 名骨科医生，大多数实践（60%）是只有一名外科医生的私人诊所。
在研究的 93 个实践中，只有 17 个（18.3%）提供了预约。这 17 个实践代表了 41 名愿意接受新医疗补助患者的骨科医生（13.3%）。如果剔除在安全网设施执业的骨科医生，这一数字将减少到 22 名（7.1%）。
结果表明，尽管医疗补助计划扩大了覆盖范围，降低了未参保率，但路易斯安那州医疗补助患者获得门诊骨科护理的机会仍然受到严重限制。
