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首页> 外文期刊>The New England journal of medicine >Auditing access to specialty care for children with public insurance.
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Auditing access to specialty care for children with public insurance.

机译：审计公共保险儿童的专业护理。

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BACKGROUND: Health care reform has expanded eligibility to public insurance without fully addressing concerns about access. We measured children's access to outpatient specialty care to identify disparities in providers' acceptance of Medicaid and the Children's Health Insurance Program (CHIP) versus private insurance. METHODS: Between January and May 2010, research assistants called a stratified, random sample of clinics representing eight specialties in Cook County, Illinois, which has a high proportion of specialists. Callers posed as mothers of pediatric patients with common health conditions requiring outpatient specialty care. Two calls, separated by 1 month, were placed to each clinic by the same person with the use of a standardized clinical script that differed by insurance status. RESULTS: We completed 546 paired calls to 273 specialty clinics and found significant disparities in provider acceptance of Medicaid-CHIP versus private insurance across all tested specialties. Overall, 66% of Medicaid-CHIP callers (179 of 273) were denied an appointment as compared with 11% of privately insured callers (29 of 273) (relative risk, 6.2; 95% confidence interval [CI], 4.3 to 8.8; P<0.001). Among 89 clinics that accepted both insurance types, the average wait time for Medicaid-CHIP enrollees was 22 days longer than that for privately insured children (95% CI, 6.8 to 37.5; P=0.005). CONCLUSIONS: We found a disparity in access to outpatient specialty care between children with public insurance and those with private insurance. Policy interventions that encourage providers to accept patients with public insurance are needed to improve access to care.
机译：背景：医疗改革扩大了公共保险的资格，而不会完全解决对访问的担忧。我们衡量了儿童访问门诊专业护理，以识别提供者对医疗补助和儿童健康保险计划（芯片）与私人保险的差异。方法：2010年1月至5月，研究助理称为伊利诺伊州库克县八种专业的分层，随机样本，具有高比例的专家。作为儿科患者的母亲提出的呼叫者患有常见的健康状况，需要门诊部专业。两个呼叫分隔在1个月，由同一个人置于同一个人的每个诊所，使用保险状况不同的标准化临床脚本。结果：我们完成了546个配对呼叫到273种特种诊所，并发现了在所有测试专业的医疗补品与私人保险的提供者接受的显着差异。总体而言，66％的医疗补货呼叫者（179名为273人）被拒绝预约，而私人被保险人的11％（第273条第29条第29条）（相对风险，6.2; 95％置信区间[CI]，4.3至8.8; p <0.001）。在89个接受保险类型的诊所中，医疗补习员入学员的平均等待时间比私人被保险儿童的平均等待时间为22天（95％CI，6.8至37.5; P = 0.005）。结论：我们在公共保险和私人保险的儿童之间获得了门诊专业护理的差异。需要鼓励提供者接受公共保险患者的政策干预，以改善护理。

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