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    Wednesday, September 14, 2005

    If the Price is Right: Patients who can't pay - and are upfront about it - have trouble getting a new doctor:

    The callers reported three different conditions: pneumonia, hypertension or a potential ectopic pregnancy (which occurs when a fertilized egg implants in the wrong place). All three can be damaging without immediate care. An ectopic pregnancy, for example, can cause severe bleeding in women unless it is addressed promptly.

    "A week would be the longest you would want to wait for these conditions," Asplin said.

    The study authors were troubled that clinics asked 98 percent of the time about insurance status, but only 28 percent of the time about the severity of the callers' medical conditions.

    And in a fourth scenario, callers indicated they were uninsured but had the ability to pay the full cost (ranging from $25 to $600) on their own. That group received almost as many follow-up appointments within one week as the callers claiming to have private insurance.

    What's most disconcerting about the study is that the same callers called the same clinics with different scenarios and got the different results. The article doesn't say how many clinics just didn't accept Medicaid, and the abstract doesn't mention it, either. But, the difference between cash paying patients who offer to pay and those who don't is striking. I would hope that would not be the same for established patients. (All of the callers in the study identified themselves as new patients for the practices.)

    This, too, seems disconcerting:

    Seventy-two percent of clinics did not attempt to determine the severity of the caller’s condition.

    Until you realize that it's standard CYA behavior in emergency rooms to tell patients to follow-up with another doctor regardless of the severity of their condition. Kind of like the boy who cried wolf. Still, a potential ectopic pregnancy needs very close follow-up no matter what (much more so than the pneumonia or blood pressure problems.) It would be interesting to see if the authors broke down the responses based on diagnosis as well.

    UPDATE: Found my issue of JAMA. Sadly, the ectopioc pregnancy cases were less likely to get an appointment than the hypertensive cases in the limited cash scenario. For some reason, though, they were more likely to get an appointment than either pneumonia cases or hypertensive cases if they had Medicaid (45.2% vs. 30.4% and 27.8% respectively.) Perhaps more obstetricians accept Medicaid.

    posted by Sydney on 9/14/2005 07:32:00 AM 0 comments


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