Overholser Stephen, Thompson Ian, Sosland Rachel, Stimson C J
Department of Urology, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
Vanderbilt University Medical Center (CJS), Nashville, Tennessee.
Urol Pract. 2016 Jul;3(4):276-282. doi: 10.1016/j.urpr.2015.09.003. Epub 2016 Apr 21.
Medicaid expansion under PPACA (Patient Protection and Affordable Care Act) sought to increase access to health care by expanding access to insurance. The association between access to Medicaid and access to urological health care, however, has not been tested to our knowledge. To test this association we performed a prospective, survey based analysis of Medicaid acceptance rates and new appointment wait times for a patient seeking urological care. This study presents baseline data collected prior to Medicaid expansion in 2014.
A primary cohort representing 20% of all urological surgeons in a nationwide database was surveyed using a simulated patient script. The data were collected in November 2013 prior to Medicaid expansion. The primary outcome measures were Medicaid acceptance and new patient appointment wait times. A practice level, secondary cohort was also analyzed.
A total of 650 urological surgeons were successfully sampled in the primary cohort, of whom 271 (41.7%) did not accept any Medicaid, 205 (31.5%) accepted some but not all Medicaid and 174 (26.8%) accepted all Medicaid insurance plans. The median wait time for a new patient appointment was 18 days. Medicaid acceptance rates were similar in the secondary cohort. The percentage of urologists accepting all forms of Medicaid varied by state, ranging from 10% to 90%.
Medicaid patient access to urological care is restricted, suggesting that access to Medicaid insurance coverage may not translate into access to urological care. Subsequent data collection will assess trends in Medicaid patient access to urological care following Medicaid expansion.
《患者保护与平价医疗法案》（PPACA）下的医疗补助计划扩张旨在通过扩大保险覆盖范围来增加医疗服务的可及性。然而，据我们所知，医疗补助计划的可及性与泌尿外科医疗服务可及性之间的关联尚未得到验证。为了验证这种关联，我们对寻求泌尿外科护理的患者的医疗补助计划接受率和新预约等待时间进行了一项基于调查的前瞻性分析。本研究呈现了2014年医疗补助计划扩张之前收集的基线数据。
使用模拟患者脚本对全国数据库中占所有泌尿外科医生20%的一个主要队列进行了调查。数据于2013年11月在医疗补助计划扩张之前收集。主要结局指标为医疗补助计划接受情况和新患者预约等待时间。还对一个实践层面的次要队列进行了分析。
在主要队列中总共成功抽取了650名泌尿外科医生，其中271名（41.7%）不接受任何医疗补助计划，205名（31.5%）接受部分但非全部医疗补助计划，174名（26.8%）接受所有医疗补助保险计划。新患者预约的中位等待时间为18天。次要队列中的医疗补助计划接受率相似。接受所有形式医疗补助计划的泌尿科医生比例因州而异，从10%到90%不等。
医疗补助计划患者获得泌尿外科护理的机会受到限制，这表明获得医疗补助保险覆盖范围并不一定意味着能够获得泌尿外科护理。后续的数据收集将评估医疗补助计划扩张后医疗补助计划患者获得泌尿外科护理的趋势。
