This paper is glimpse into the sad realities brought about by the class warfare unveiled by the current US public/private insurance system.
They looked at all 102 Dallas-Fort Worth orthopaedic groups. All groups were called twice from a patient discharged from the ED with an ankle fracture who utilized a standardized script- one call saying they were uninsured, another saying they had either private insurance or medicaid. All in all, 204 calls were made (59 private, 43 medicaid, 102 uninsured).
Success rate for ability to make a follow up appointment:
83.1% for privately insured
81.4% for uninsured
14% for medicaid callers
Controlling for paired calls to same practice, an uninsured caller had almost a 6x higher rate of follow up than medicaid callers. Also despicable is that the uninsured had to bring a median of $350 to their first appointment (less than 2% were asked to bring $100 or less) – or, 48% more than the usual total payment collection from a privately insured patient ($236), and 273% more than the usual payment collected from medicaid ($128).
Want more heinous activity? 48% of uninsured patients were directed to the ED when they asked where they could go.
Wait, you want more? Of the ortho practices that appeared on medicaids list of practices accepting new patients:
15 of 38 told callers they did not accept medicaid
11 said they did not treat ankles
9 had non-working numbers
3 actually scheduled an appointment
Less than 10% of medicaid patients were able to secure an appointment with ortho practices that were on medicaid’s list of providers accepting new patients! Either their database needs updating, or the practices are outright lying. Given the difference in payments between the uninsured, private patients, and medicaid patients, I suspect the problems lay on the side of the individual practices.
Emergency Medicine- the front lines and safety net.