Monday, June 27, 2011

Benefit of the sick

Posted By on Mon, Jun 27, 2011 at 5:14 PM

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The New York Times published an interesting article that is certain to ring the alarms among certain conservative circles.

In it, the Times details a program that the Obama administration has implemented that would use "mystery shoppers" — people who do not identify their hidden agenda — to call doctors' offices and claim that they are in need of medical care. The goal is to discern if there is a difference between how a person is treated when they say that they will be using private insurance as opposed to those who say that they will be using Medicaid.

Washington-based internist Dr. Raymond Scalettar reportedly told the paper: “I don’t like the idea of the government snooping ... It’s a pernicious practice — Big Brother tactics, which should be opposed.”

The administration says the survey will address a “critical public policy problem”: the increasing shortage of primary care doctors, including specialists in internal medicine and family practice. It will also try to discover whether doctors are accepting patients with private insurance while turning away those in government health programs that pay lower reimbursement rates.

Federal officials predict that more than 30 million Americans will gain coverage under the health care law passed last year. “These newly insured Americans will need to seek out new primary care physicians, further exacerbating the already growing problem” of a shortage of such physicians in the United States, the Department of Health and Human Services said in a description of the project prepared for the White House.

Plans for the survey have riled many doctors because the secret shoppers will not identify themselves as working for the government.

What the survey has found in Illinois, as the Times had reported a couple days ago, is that "children with Medicaid are far more likely than those with private insurance to be turned away by medical specialists or be made to wait more than a month for an appointment, even for serious medical problems."

The New England Journal of Medicine has published the findings.

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).

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