Primary Care Access to New Patient Appointments for California Medicaid Enrollees: A Simulated Patient Study.
| Publication Type | Academic Article |
| Authors | Melnikow J, Evans E, Xing G, Durbin S, Ritley D, Daniels B, Woodworth L |
| Journal | Ann Fam Med |
| Volume | 18 |
| Issue | 3 |
| Pagination | 210-217 |
| Date Published | 05/01/2020 |
| ISSN | 1544-1717 |
| Keywords | Appointments and Schedules, Health Services Accessibility, Medicaid, Primary Health Care |
| Abstract | PURPOSE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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. |
| DOI | 10.1370/afm.2502 |
| PubMed ID | 32393556 |
| PubMed Central ID | PMC7214003 |