Burman Abigail, Haeder Simon F
Yale University.
Pennsylvania State University.
J Health Polit Policy Law. 2022 Jun 1;47(3):319-349. doi: 10.1215/03616878-9626866.
The accuracy of provider directories and whether consumers can schedule timely appointments are crucial determinants of health access and outcomes.
We evaluated accuracy and timely access data obtained from the California Department of Managed Health Care, consisting of responses to large, random, representative surveys of primary care providers, cardiologists, endocrinologists, and gastroenterologists for 2018 and 2019 for all managed care plans in California.
Surveys were able to verify provider directory entries for the four specialties for 59% to 76% of listings or 78% to 88% of providers reached. We found that consumers were able to schedule urgent care appointments for 28% to 54% of listings or 44% to 72% of accurately listed providers. For general care appointments, the percentages ranged from 35% to 64% of listed providers or 51% to 87% of accurately listed providers. Differences across markets related to accuracy were generally small. Medi-Cal plans outperformed other markets with regard to timely access. Primary care consistently outperformed all other specialties. Timely access rates were higher for general appointments than for urgent care appointments.
Our finding raise questions about the regulatory regime as well as consumer access and health outcomes.
医疗服务提供者名录的准确性以及消费者能否及时预约是影响医疗可及性和治疗效果的关键因素。
我们评估了从加利福尼亚州管理式医疗保健部获取的准确性和及时预约数据，这些数据来自对2018年和2019年加利福尼亚州所有管理式医疗保健计划的初级保健医生、心脏病专家、内分泌专家和胃肠病专家进行的大规模、随机、代表性调查的回复。
调查能够核实四个专业领域中59%至76%的名录条目或联系到的提供者中的78%至88%。我们发现，消费者能够为28%至54%的名录条目或44%至72%的准确列出的提供者安排紧急护理预约。对于普通护理预约，这一比例在列出的提供者的35%至64%或准确列出的提供者的51%至87%之间。不同市场在准确性方面的差异通常较小。在及时预约方面，医疗救助计划表现优于其他市场。初级保健一直优于所有其他专业领域。普通预约的及时预约率高于紧急护理预约。
我们的研究结果对监管制度以及消费者的医疗可及性和健康结果提出了疑问。
