Article Figures & Data
Figures
- Figure 1
Appointment rates for private insurance, by call wave.
aDifference statistically significant at P <.05.
- Figure 2
Appointment rates for Medicaid, by call wave.
aDifference statistically significant at P <.05.
- Figure 3
Wait times (calendar days to appointment) for private insurance, by call wave.
Note: Horizontal lines in boxes represent median interval days to appointment. Upper and lower edges of boxes represent the 75th and 25th percentiles, respectively. Upper and lower ends of whiskers represent maxima and minima, respectively.
- Figure 4
Wait times (calendar days to appointment) for Medicaid, by call wave.
Note: Horizontal lines in boxes represent median interval days to appointment. Upper and lower edges of boxes represent the 75th and 25th percentiles, respectively. Upper and lower ends of whiskers represent maxima and minima, respectively.
Tables
First call wave (2012–2013) Second call wave (2014) Private Medicaid Private Medicaid Sample sizes, No. 10 States 5,385 4,352 2,424 2,474 Arkansas 418 249 250 248 Georgia 634 517 261 293 Illinois 632 596 266 281 Iowa 383 373 250 261 Massachusetts 905 714 228 251 Montana 124 108 121 120 New Jersey 637 478 278 278 Oregon 414 296 244 212 Pennsylvania 582 540 255 267 Texas 656 481 271 263 Month of call, No. Jan 1,801 1,562 0 0 Feb 890 723 0 0 Mar 218 115 0 0 Apr 4 0 0 0 May 0 0 1,805 583 Jun 0 0 595 1,546 Jul 0 0 24 339 Aug 0 0 0 6 Sep 0 0 0 0 Oct 0 0 0 0 Nov 848 657 0 0 Dec 1,624 1,295 0 0 Hypertension scenario, % 50.9 50.4 49.8 49.9 Female caller, % 50.6 49.4 51 54.4 Race/ethnicity of caller, % White 39.5 36.8 43 45.6 Black 37.9 38.9 42.3 41.4 Hispanic 22.6 24.3 14.7 13.1 Age of caller, % Age 18–29 22.1 22.7 24.8 24.8 Age 30–44 51.0 50.5 47.8 45.8 Age 45–64 26.9 26.8 27.4 29.4
The Article in Brief
Access to Primary Care Appointments Following 2014 Insurance Expansions: The Sky is Not Falling
Karin V. Rhodes , and colleagues
Background The number of newly insured individuals in the US reached 20 million by early 2016 and has continued to grow. This has raised concerns about whether the primary care system can absorb millions of new patients seeking care.
What This Study Found There is no evidence as of mid-2014 that the millions of individuals newly covered through Medicaid and the Patient Protection and Affordable Care Act strained primary care capacity. This was demonstrated by stability in appointment rates and wait times for new, privately insured patients and an increase in appointment access for new Medicaid patients in 10 study states. An audit of simulated patient calls to primary care practices for new-patient appointments found overall appointment rates for private insurance remained stable from 2012 to 2014 with Massachusetts and Pennsylvania experiencing significant increases. Medicaid appointment rates increased 10 percentage points with substantial variation by state. Across all callers, median wait times for those obtaining an appointment were seven days in 2012 and five days in 2014, but the difference was not statistically significant. In addition to the possibility that there was sufficient capacity to absorb the new patients, the authors posit several alternative explanations for not finding a decline in primary care availability despite the millions of newly insured. Possibilities include efficiencies created by components of the Patient-Centered Medical home model such as team-based care, after-hours and weekend care, electronic medical records, and telephone and e-mail communications; and broad trends in care reorganizations such as Accountable Care Organizations, alternative payment arrangements, and practice mergers that provide economies of scale.
Implications
- The authors conclude it will be important to continue tracking appointment availability and wait times in primary care.
