Auditing access to specialty care for children with public insurance

New England Journal of Medicine

Volumn 364, Issue 24, 2011, Pages 2324-2333

  Bisgaier, Joanna ^a   Rhodes, Karin V ^a  

^a UNIVERSITY OF PENNSYLVANIA   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CHILD CARE; CHILDREN'S HEALTH INSURANCE PROGRAM; HEALTH CARE ACCESS; HEALTH CARE POLICY; HEALTH INSURANCE; HUMAN; MEDICAID; MEDICAL AUDIT; MEDICAL SPECIALIST; OUTPATIENT CARE; PRIORITY JOURNAL; STANDARD; UNITED STATES;

EID: 79959297709     PISSN: 00284793     EISSN: 15334406     Source Type: Journal    
DOI: 10.1056/NEJMsa1013285     Document Type: Article

References (47)

1. Sebelius K. Ensuring success: must focus on patients, eliminating inefficiencies. New York: Commonwealth Fund, July 2010. (http://www. commonwealthfund.org/Content/Blog/Jul/Ensuring-Success.aspx.)
2. Idem. CHIPRA one year later: connecting kids to coverage. Washington, DC: Department of Health and Human Services. (http://www.insurekidsnow.gov/chip/ report.html.)
3. Newacheck PW, Pearl M, Hughes DC, Halfon N. The role of Medicaid in ensuring children's access to care. JAMA 1998;280:1789-93. (Pubitemid 28536884)
4. CHIP ever enrolled in year, FY 2009. Baltimore: Centers for Medicare & Medicaid Services, 2010. (https://www.cms.gov/NationalCHIPPolicy/ downloads/CHIPEverEnrolledYearGraph.pdf.)
5. Medicaid children, title XIX SEDS report. Baltimore: Centers for Medicare & Medicaid Services, 2009. (https://www.cms.gov/NationalCHIPPolicy/ downloads/MedicaidChildrenSEDSReportFY2008.pdf.)
6. Ferrer RL. Pursuing equity: contact with primary care and specialist clinicians by demographics, insurance, and health status. Ann Fam Med 2007;5:492-502. (Pubitemid 350248580)
7. Iobst C, King W, Baitner A, Tidwell M, Swirsky S, Skaggs DL. Access to care for children with fractures. J Pediatr Orthop 2010;30:244-7.
8. Decker SL. Medicaid physician fees and the quality of medical care of Medicaid patients in the USA. Rev Econ Household 2007;5:95-112.
9. Skaggs DL, Lehmann CL, Rice C, et al. Access to orthopedic care for children with Medicaid versus private insurance: results of a national survey. J Pediatr Orthop 2006;26:400-4. (Pubitemid 44357071)
10. Hwang AH, Hwang MM, Xie HW, Hardy BE, Skaggs DL. Access to urologic care for children in California: Medicaid versus private insurance. Urology 2005;66:170-3. (Pubitemid 41002209)
11. Wang EC, Choe MC, Meara JG, Koempel JA. Inequality of access to surgical specialty health care: why children with government-funded insurance have less access than those with private insurance in Southern California. Pediatrics 2004;114(e):e584-e590. (Pubitemid 41647666)
12. Ortega AN, Belanger KD, Paltiel AD, Horwitz SM, Bracken MB, Leaderer BP. Use of health services by insurance status among children with asthma. Med Care 2001;39:1065-74. (Pubitemid 33691381)
13. Skaggs DL, Clemens SM, Vitale MG, Femino JD, Kay RM. Access to orthopedic care for children with Medicaid versus private insurance in California. Pediatrics 2001;107:1405-8. (Pubitemid 32525224)
14. Skinner AC, Mayer ML. Effects of insurance status on children's access to specialty care: a systematic review of the literature. BMC Health Serv Res 2007;7:194.
15. Institute of Medicine, Committee on Monitoring Access to Personal Health Care Services. Access to health care in America. Washington, DC: National Academy Press, 1993:229.
16. Gold M, Kuo S, Taylor EF. Translating research to action: improving physician access in public insurance. J Ambul Care Manage 2006;29:36-50. (Pubitemid 44481140)
17. Dubay L, Guyer J, Mann C, Odeh M. Medicaid at the ten-year anniversary of SCHIP: looking back and moving forward. Health Aff (Millwood) 2007;26:370-81.
18. Porterfield SL, McBride TD. The effect of poverty and caregiver education on perceived need and access to health services among children with special health care needs. Am J Public Health 2007;97:323-9. (Pubitemid 47279382)
19. Fix M, Struyk RJ. Clear and convincing evidence: measurement of discrimination in America. Washington, DC: Urban Institute Press, 1993.
20. The Medicaid Access Study Group. Access of Medicaid recipients to outpatient care. N Engl J Med 1994;330:1426-30.
21. Asplin BR, Rhodes KV, Levy H, et al. Insurance status and access to urgent ambulatory care follow-up appointments. JAMA 2005;294:1248-54. (Pubitemid 41352113)
22. Galbraith AA, Grossman DC, Koepsell TD, Heagerty PJ, Christakis DA. Medicaid acceptance and availability of timely follow-up for newborns with Medicaid. Pediatrics 2005;116:1148-54. (Pubitemid 46056421)
23. Census Bureau. 2010 census data: redistricting data (interactive map). (http://2010.census.gov/2010census/data.)
24. Area Resource File. Washington, DC: Health Resources and Services Administration, 2008. (http://arf.hrsa.gov/arfwebtool/HRCCTDataSources.pdf.)
25. Coughlin TA, Cohen M. A race to the top: Illinois's All Kids Initiative. Report for the Kaiser Commission on Medicaid and the Uninsured, 2007. (http://www.kff.org/uninsured/upload/7677.pdf.)
26. Children's Health Insurance Program, plan activity as of April 23, 2010. Washington, DC: Centers for Medicare and Medicaid Services, 2010. (http://www.cms.gov/LowCostHealthInsFamChild/downloads/CHIPStatePlanActivityMap. pdf.)
27. Market Share Reports. 2008 Illinois premium for HMO, LHSO, dental, and voluntary type companies. Springfield: Illinois Department of Insurance, 2008. (http://insurance.illinois.gov/Reports/Market-Share/2008/08HealthPremiumReport. xls.)
28. McManus M, Fox H, Limb S, et al. New workforce, practice, and payment reforms essential for improving access to pediatric subspecialty care within the medical home. Arch Pediatr Adolesc Med 2009;163:200-2.
29. Forrest CB. A typology of specialists' clinical roles. Arch Intern Med 2009;169:1062-8.
30. Kasser JR. Location of treatment of supracondylar fractures of the humerus in children. Clin Orthop Relat Res 2005;434:110-3. (Pubitemid 40617503)
31. Kogan MD, Newacheck PW, Blumberg SJ, et al. Underinsurance among children in the United States. N Engl J Med 2010;363:841-51.
32. Rosenbaum S. A "customary and necessary" program - Medicaid and health care reform. N Engl J Med 2010;362:1952-5.
33. Iglehart JK. Medicaid expansion offers solutions, challenges. Health Aff (Millwood) 2010;29:230-2.
34. Cunningham PJ, Nichols LM. The effects of Medicaid reimbursement on the access to care of Medicaid enrollees: a community perspective. Med Care Res Rev 2005;62:676-96.
35. Berman S, Dolins J, Tang SF, Yudkowsky B. Factors that influence the willingness of private primary care pediatricians to accept more Medicaid patients. Pediatrics 2002;110:239-48. (Pubitemid 34833005)
36. Coburn AF, Long SH, Marquis MS. Effects of changing Medicaid fees on physician participation and enrollee access. Inquiry 1999;36:265-79.
37. Illinois Department of Healthcare and Family Services. Physician fee schedule key revised 7-01-09. (http://www.hfs.illinois.gov/assets/070109fee.pdf. )
38. Perloff JD, Kletke P, Fossett JW. Which physicians limit their Medicaid participation, and why. Health Serv Res 1995;30:7-26.
39. Backus L, Osmond D, Grumbach K, Vranizan K, Phuong L, Bindman AB. Specialists' and primary care physicians' participation in Medicaid managed care. J Gen Intern Med 2001;16:815-21. (Pubitemid 34015696)
40. Komaromy M, Grumbach K, Drake M, et al. The role of black and Hispanic physicians in providing health care for underserved populations. N Engl J Med 1996;334:1305-10. (Pubitemid 26138012)
41. Greene J, Blustein J, Weitzman BC. Race, segregation, and physicians' participation in Medicaid. Milbank Q 2006;84:239-72. (Pubitemid 43855782)
42. Margolis PA, Cook RL, Earp JA, Lannon CM, Keyes LL, Klein JD. Factors associated with pediatricians' participation in Medicaid in North Carolina. JAMA 1992;267:1942-6.
43. Association of American Medical Colleges. Teaching hospitals and medical school faculty practice groups are major healthcare providers for Medicaid beneficiaries and the uninsured. (http://www.aamc.org/advocacy/library/ teachhosp/051810.pdf.)
44. Cunningham PJ, Hadley J. Effects of changes in incomes and practice circumstances on physicians' decisions to treat charity and Medicaid patients. Milbank Q 2008;86:91-123.
45. Bodenheimer T. Coordinating care - a perilous journey through the health care system. N Engl J Med 2008;358:1064-71.
46. Stille CJ, McLaughlin TJ, Primack WA, Mazor KM, Wasserman RC. Determinants and impact of generalist-specialist communication about pediatric outpatient referrals. Pediatrics 2006;118:1341-9. (Pubitemid 46393777)
47. Chen AH, Kushel MB, Grumbach K, Yee HF Jr. A safety-net system gains efficiencies through 'eReferrals' to specialists. Health Aff (Millwood) 2010;29:969-71.