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Do Clinics Favor Insured for Follow-Up Visits?

Sept. 13, 2005 - People covered by private health insurance may be more likely to receive follow-up care within a week for an urgent medical condition than those with Medicaid or without health insurance.

A new study shows that callers claiming to have private health insurance were about twice as likely to get a follow-up appointment at an ambulatory clinic within a week after an emergency room visit than those without insurance or with Medicaid.

The results suggest that callers' health insurance status may be more important to most people answering the phones and scheduling appointments at ambulatory care clinics than their health status.

Researchers say that while 98% of the clinics contacted screened callers for health insurance status, only 28% attempted to determine the severity of the callers' medical condition.

Health Insurance Makes a Difference

Researchers say Americans will make about 114 million visits to hospital emergency departments in 2005 and more than 80% will be treated and discharged with recommendations for follow-up care. But many uninsured people often experience problems making follow-up appointments within the recommended time frame.

In the study, published in The Journal of the American Medical Association, researchers looked at the role insurance status plays in securing a follow-up appointment for an urgent medical condition identified during an emergency room visit.

Research assistants made calls to nearly 500 ambulatory clinics in nine U.S. cities from May 2002 to February 2003 and identified themselves as new patients who had been treated in an emergency room and required an urgent follow-up appointment within a week. Callers read a script detailing one of three possible medical scenarios requiring follow-up, including pneumonia, high blood pressure, or a possible ectopic pregnancy (a potentially life-threatening, early pregnancy occurring outside the uterus, such as within the fallopian tube).

The same assistant called each clinic twice with the same medical scenario but with a different insurance status.

Insured vs. Noninsured: Getting an Appointment

The results showed that the availability of follow-up appointments varied according to insurance status. For example:

• 64% of callers with private insurance were offered a follow-up appointment within a week vs. 47% of callers overall.
• Callers with private health insurance were more likely to receive appointments than those claiming to have Medicaid coverage (64% vs. 34%)
• Callers with private health insurance also had higher appointment rates than those without insurance who offered to pay $20 and arrange for payment of the balance (65% vs. 25%)

But researchers found no difference in follow-up appointment rates between those with private insurance and uninsured people willing to pay cash for the entire visit fee (about $100 for a typical visit).

"These study findings suggest that reported insurance status influences access to follow-up appointments for patients with conditions requiring urgent ambulatory follow-up care," write researcher Bret Asplin, MD, MPH, of the department of emergency medicine at Regions Hospital and HealthPartners Research Foundation in St. Paul, Minn., and colleagues. "Although the ultimate consequences of these access barriers are not known, they may result in patients delaying needed follow-up care, risking adverse outcomes, or requiring additional emergency care or hospitalization."