Greedy medical specialists refuse to treat most children with serious health problems if they have public insurance

Wednesday, June 15, 2011 by: S. L. Baker, features writer
Tags: medical specialists, children, health news

(NaturalNews) Doctors are refusing to help sick kids -- or delaying their treatment for weeks to months -- if the children don't have private insurance. That's because private insurance pays docs bigger bucks in reimbursements than the public kind of insurance like Medicaid. What makes this startling finding especially disgusting is that the physicians in question are specialists needed by youngsters who are seriously ill.

These facts were just revealed in an audit study conducted by researchers from the Perelman School of Medicine and the School of Social Policy and Practice at the University of Pennsylvania. The findings, published in the June 16 issue of the New England Journal of Medicine, showed that 66 percent of publicly insured children were unable to get an appointment with a doctor for potentially life-threatening medical conditions -- including diabetes and seizures -- that required outpatient specialty care. But if youngsters with identical health problems and symptoms had the higher paying private insurance, they were turned away by doctors only 11 percent of the time.

"We found disturbing disparities in specialty physicians' willingness to provide outpatient care for children with public insurance -- even those with urgent and severe health problems. This study shows a failure to care for our most vulnerable children," senior author Karin V. Rhodes, MD, MS, director of Emergency Care Policy Research in Penn's Department of Emergency Medicine and a senior fellow in the Leonard Davis Institute of Health Economics, said in a media statement.

What's more, the study also uncovered facts indicating that some specialists apparently think they can thumb their noses at federal law which is supposed to require that Medicaid recipients have the same access to medical care as the general population in their community. Bottom line: the researchers found that Medicaid and Children's Health Insurance Program (CHIP)-insured children who were able to even get an appointment with a specialist had to wait far longer to be seen than kids with private insurance.

It almost sounds like the specialists are inflicting a kind of punishment on kids who have the "wrong" kind of public insurance that doesn't pay the doctors as much in reimbursements as private insurance. Sick kids with Medicaid or CHIP had to wait over a month, about 44 days, for help. But privately-insured children with similar urgent conditions were seen in less than three weeks.

For the study, research assistants compiled facts by working undercover -- they posed as moms of children with seven common medical that affect large numbers of children and are serious enough to need timely specialty care: severe body rashes, obstructed breathing during sleep, Type 1 diabetes, uncontrolled asthma, severe depression, new onset seizures and a fracture that could affect bone growth.

The researchers, pretending to be mothers, placed calls to a random sample of 273 clinics representing eight medical specialties in Cook County, Pennsylvania. Each of the investigators placed two calls, separated by one month, to each clinic using a script that varied only by insurance status. Only 34 percent of callers with Medicaid-insured children were told they could even get an appointment with the specialist. But if the researchers-posing-as-moms claimed they were calling about a child with Blue Cross Blue Shield PPO insurance, 89 percent were given appointments.

It was obvious that how the doctor was going to get paid -- whether by higher paying private insurance or by lesser paying public insurance -- was of far more importance to the specialists' offices than the severity of the child's reported symptoms.

What's the evidence for this? In more 50 percent of calls to clinics, the caller was first asked for the child's specific type of insurance coverage before being told whether an appointment could be scheduled with the doctor. In fact, in 52 percent of the time, the type of insurance coverage was the very first question asked.

The University of Pennsylvania researchers who carried out the study noted in a press statement that previous studies have found that reimbursement amounts are the main reason doctors decide whether or not to treat patients with public insurance. But the authors of the new study think the health systems in which the doctors work may play the biggest role of all -- because medical centers may have incentives that encourage doctors to avoid patients who don't have the higher paying private insurance. This has created policies based on making the most money rather than policies based on what's best for seriously ill kids.

"We studied the health system, not individual providers," Dr. Rhodes said in a media statement. "To reduce disparities, we may need to restructure reimbursement strategies and reorganize the manner in which our health system provides specialty care. We can fix this problem, but it will not happen unless we are willing to make the health of American children a national priority."

For more information:
http://www.uphs.upenn.edu/news/