W. Hsiang1, S. Lee1, C. McGeoch1, W. Cheung1, R. Becher1, K. A. Davis1, K. Schuster1 1Yale University School Of Medicine,General Surgery, Trauma And Surgical Critical Care,New Haven, CT, USA
Introduction:
The expansion of Medicaid under the Affordable Care Act (ACA) extended coverage to any individual with incomes up to 138% of the federal poverty level. As of January 2017, 31 states and the District of Columbia have elected to expand Medicaid. Our study investigated the impact of the type of insurance on access to elective inguinal hernia repair and the disparities in access between expansion and non-expansion states.
Methods:
Using the Amercian College of Surgeons directory, 240 hernia repair surgeons across eight states (four which have expanded Medicaid [NY, CA, OH, IL] and four which have not [TX, FL. NC, GA]) were randomly selected. Investigators posed as simulated patients seeking an evaluation for an inguinal hernia and phoned selected surgeons. Physician offices were contacted using a standardized script from a caller ID-blocked phone number at three separate occasions to assess responses to three different insurance types (Blue Cross, Medicaid, Medicare). Appointment success rates and waiting periods were compared between published Medicaid and Blue Cross or Medicare scenarios.
Results:
Of 240 surgeons contacted, 75.4% scheduled appointments for Medicaid patients, compared to 98.8% for Medicare patients and 98.3% for those with Blue Cross (p<0.001). In states that expanded Medicaid, fewer offices accepted Medicaid patients compared to those in non-expanded States (68.3% vs 82.5%, P=0.011). No differences in wait times between expanded and non-expanded states were observed. Surgeons in urban settings were less likely to accept Medicaid patients than non-urban offices (70.6% vs 82.5%, P=0.036) while solo practices were less likely to accept Medicaid patients than group practices (50.0% vs 79.0%, P<0.001). No differences in the acceptance of Medicaid patients between academic and private practice surgeons were noted (P=0.516).
Conclusion:
Simulated Medicaid patients were less successful at scheduling appointments for surgical consultation than Blue Cross or Medicare patients. Despite expanded Medicaid, fewer surgeons in expansion states accepted Medicaid patients. These findings should be further investigated with future changes in Medicaid to understand impact on access to surgical care.