Primary care access for new patients depends on insurance type, study says

April 11, 2014

Patients with private insurance have a better chance of scheduling appointments with doctors than those with Medicaid, according to a new study.

Access to primary care services for new Affordable Care Act (ACA) and Medicaid enrollees varies widely depending on where patients are located and what type of insurance they have. Patients with private insurance have a better chance of scheduling appointments with doctors than those with Medicaid, according to a new study.

The Journal of the American Medical Association made nearly 13,000 phone calls to 7,778 primary care practices in 10 states requesting appointments over a five-month period. The study found that nearly 85% of callers with private insurance were able to schedule appointments with primary care physicians, and only 58% of Medicaid callers were able to do so. Uninsured callers who could make a full cash payment in advance were able to schedule appointments nearly 79% of the time. However, when callers said they lacked insurance and could pay no more than $75 in advance, only 15% were able to schedule appointments.

Primary care practices in Arkansas, Georgia, Illinois, Iowa, Massachusetts, Montana, New Jersey, Oregon, Pennsylvania, and Texas were called. Those states are home to about one-third of nonelderly adults who are either uninsured or covered by Medicaid.

The study’s authors say that just having insurance doesn’t guarantee access to primary care, even though Medicaid expansion and the healthcare exchanges aimed to increase the number of people receiving healthcare.

“Given that access to primary care is considered a prerequisite for improved population health outcomes, a strained primary care system may place many of the goals of the ACA at risk,” the study’s authors say. They estimate that about 24 million people will enter the healthcare system through ACA plans by 2023.

The authors say Medicaid patients and those with high-deductible plans will have a harder time securing appointments in the future, as healthcare insurance market continues to expand.

“Consumers should be able to search to see whether the physician they want is part of a given plan's network and learn whether that practice is accepting new patients,” the authors say. “In anticipation of large insurance expansions in the public and private insurance markets, it will be important that navigator programs not only help patients enroll but also help them select plans that include practices with appointment availability and a primary care physician that is accepting new patients.”