Specialist Access No Better With Adoption of Access Standards
TUESDAY, Aug. 15, 2017 -- Adoption of specialty access standards does not improve access to specialists, according to a study published online Aug. 14 in JAMA Internal Medicine.
Chima D. Ndumele, Ph.D., from the Yale School of Public Health in New Haven, Conn., and colleagues compared ratings of access to specialists for adult Medicaid and commercial enrollees before and after implementation of standards for specialty access. Consumer Assessment of Healthcare Providers and Systems survey data were used to perform a quasiexperimental difference-in-differences analysis of 20,163 nonelderly adult Medicaid managed care (MMC) enrollees and 54,465 commercially insured enrollees in five states adopting access standards, and in 37,290 MMC enrollees in five states that previously adopted access standards.
The researchers found that before policy implementation, 69 percent of Medicaid enrollees and 75 percent of commercial enrollees reported that it was always or usually easy to get an appointment with a specialist, compared with 67 percent of Medicaid enrollees in states that had previously implemented access standards. In the period following the implementation of standards, no significant improvement was seen in timely access to specialty services for MMC enrollees, nor did access standards impact insurance-based disparities in access. Heterogeneity was seen across states.
"Specialty access standards did not lead to widespread improvements in access to specialist physicians," the authors write. "Meaningful improvements in access to specialty care for Medicaid recipients may require additional interventions."
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Posted: August 2017