Center for Healthcare for Policy and Research, University of California, Davis, Davis, California
Department of Social Work, California State University, Sacramento, Sacramento, California.
Ann Fam Med. 2020 May;18(3):210-217. doi: 10.1370/afm.2502.
We undertook a study to evaluate variation in the availability of primary care new patient appointments for Medi-Cal (California Medicaid) enrollees in Northern California, and its relationship to emergency department (ED) use after Medicaid expansion.
We placed simulated calls by purported Medi-Cal enrollees to 581 primary care clinicians (PCCs) listed as accepting new patients in online directories of Medi-Cal managed care plans. Data from the California Health Interview Survey, Medi-Cal enrollment reports, and California hospital discharge records were used in analyses. We developed multilevel, mixed-effect models to evaluate variation in appointment access. Multiple linear regression was used to examine the relationship between primary care access and ED use by county.
Availability of PCC new patient appointments to Medi-Cal enrollees lacking a PCC varied significantly across counties in the multilevel model, ranging from 77 enrollees (95% CI, 70-81) to 472 enrollees (95% CI, 378-628) per each available new patient appointment. Just 19% of PCCs had available appointments within the state-mandated 10 business days. Clinicians at Federally Qualified Health Centers had higher availability of new patient appointments (rate ratio = 1.56; 95% CI, 1.24-1.97). Counties with poorer PCC access had higher ED use by Medi-Cal enrollees.
In contrast to findings from other states, access to primary care in Northern California was limited for new patient Medi-Cal enrollees and varied across counties, despite standard statewide reimbursement rates. Counties with more limited access to primary care new patient appointments had higher ED use by Medi-Cal enrollees.
我们进行了一项研究，评估了北加州 Medi-Cal（加州医疗补助计划）参保者获得初级保健新患者预约的机会的变化，并评估了其与医疗补助扩大后急诊部（ED）使用的关系。
我们以 Medi-Cal 参保者的名义向 581 名初级保健临床医生（PCC）拨打了模拟电话，这些医生都列在 Medi-Cal 管理式医疗计划在线目录中，表示愿意接受新患者。分析中使用了来自加利福尼亚健康访谈调查、Medi-Cal 登记报告和加利福尼亚医院出院记录的数据。我们开发了多水平混合效应模型来评估预约机会的变化。采用多元线性回归来检验县级初级保健机会与 ED 使用之间的关系。
在多水平模型中，缺乏初级保健临床医生的 Medi-Cal 参保者获得 PCC 新患者预约的机会在各县之间差异显著，每个可提供的新患者预约名额从 77 名参保者（95%CI，70-81）到 472 名参保者（95%CI，378-628）不等。只有 19%的 PCC 在州规定的 10 个工作日内有预约。符合联邦合格医疗中心标准的临床医生拥有更高的新患者预约机会（相对比率=1.56；95%CI，1.24-1.97）。初级保健机会较差的县 Medi-Cal 参保者的 ED 使用量更高。
与其他州的研究结果相反，尽管全州有标准的报销率，但北加州新 Medi-Cal 参保者获得初级保健的机会有限，而且各县之间存在差异。初级保健新患者预约机会更有限的县，Medi-Cal 参保者的 ED 使用量更高。
