University of Colorado Anschutz School of Medicine, Aurora, CO.
University of Colorado Anschutz School of Medicine, Aurora, CO.
Am J Obstet Gynecol. 2023 Jun;228(6):722.e1-722.e9. doi: 10.1016/j.ajog.2023.03.004. Epub 2023 Mar 11.
Previous research suggests that access to healthcare may influence the diagnosis and treatment of obstetrical and gynecologic pathologies. Audit studies, a single-blinded and patient-centered design, have been employed to measure access to care for health services. To date, no study has assessed the dimensions of access to obstetrics and gynecologic subspecialty care based on insurance type (Medicaid vs commercial).
This study aimed to evaluate the mean appointment wait time for a new patient visit to female pelvic medicine and reconstructive surgery, gynecologic oncology, maternal-fetal medicine, and reproductive endocrinology and infertility when presenting with Medicaid vs commercial insurance.
Each subspecialty medical society has a patient-facing physician directory of physicians across the United States. Of note, 800 unique physicians were randomly selected from the directories (200 per subspecialty). Of the 800 physicians, each physician was called twice. The caller presented with Medicaid or, in a separate call, with Blue Cross Blue Shield. The order in which the calls were placed was randomized. The caller asked for the soonest appointment available for respective medical conditions based on subspecialty: stress urinary incontinence, new-onset pelvic mass, preconceptual counseling after an autologous kidney transplant, and primary infertility.
From 800 physicians initially contacted, 477 responded to at least 1 call in 49 states plus the District of Columbia. The mean appointment wait time was 20.3 business days (standard deviation, ±18.6). A significant difference was found in new patient appointment wait times by type of insurance, with 44% longer wait time for Medicaid (ratio, 1.44; 95% confidence interval, 1.34-1.54; P<.001). When the interaction between insurance type and subspecialty was added to the model, it was also highly significant (P<.01). More specifically, Medicaid patients in female pelvic medicine and reconstructive surgery had a longer wait time than commercially insured patients. Patients seeking care in maternal-fetal medicine had the least difference, but Medicaid-insured patient wait times were still longer than commercial-insured patient wait times.
Typically, a patient can expect to wait 20.3 days for a new patient appointment with a board-certified obstetrics and gynecology subspecialist. Callers presenting with Medicaid insurance experienced significantly longer new patient appointment wait times than callers with commercial insurance.
先前的研究表明，获得医疗保健的机会可能会影响妇产科疾病的诊断和治疗。审核研究采用单盲和以患者为中心的设计，用于衡量医疗服务的获得情况。迄今为止，尚无研究根据保险类型（医疗补助与商业保险）评估妇产科亚专科护理的获得情况。
本研究旨在评估因患有尿失禁、新发盆腔肿块、自体肾移植后孕前咨询和原发性不孕等疾病，使用医疗补助和商业保险就诊时，妇产科、妇科肿瘤学、母胎医学和生殖内分泌与不孕亚专科的新患者预约等待时间的平均值。
每个亚专科医学协会都有一个面向患者的医生名录，其中包括美国各地的医生。值得注意的是，从名录中随机选择了 800 名独特的医生（每个亚专科 200 名）。在这 800 名医生中，每位医生都被致电两次。致电者出示医疗补助或在另一次电话中出示蓝十字蓝盾。电话拨打的顺序是随机的。致电者根据亚专科询问各自疾病的最快预约时间：压力性尿失禁、新发盆腔肿块、自体肾移植后孕前咨询和原发性不孕。
最初联系的 800 名医生中，有 477 名医生在 49 个州和哥伦比亚特区回复了至少 1 次电话。新患者预约等待时间的平均值为 20.3 个工作日（标准差±18.6）。根据保险类型，新患者预约等待时间存在显著差异，医疗补助的等待时间长 44%（比值，1.44；95%置信区间，1.34-1.54；P<.001）。当将保险类型和亚专科之间的交互作用添加到模型中时，差异也具有统计学意义（P<.01）。更具体地说，女性盆底医学和重建外科的医疗补助患者等待时间长于商业保险患者。寻求母胎医学治疗的患者差异最小，但医疗补助保险患者的等待时间仍长于商业保险患者的等待时间。
通常情况下，患者可以预期在与妇产科亚专科认证医生预约新患者时等待 20.3 天。使用医疗补助保险的呼叫者经历的新患者预约等待时间明显长于使用商业保险的呼叫者。
