7/12/11 A recent report from the Government Accounting Office, or GAO, found that primary-care and specialty-care physicians are less likely to accept children insured by Medicaid and the Children’s Health Insurance Program, or CHIP – two federal programs for low-income families – than they are to accept privately insured children. This, coupled with a severe shortage of pediatric rheumatologists in the U.S., means that many children with arthritis may have a hard time getting appropriate care.
The GAO report showed that more than 75 percent of primary-care and specialty-care physicians in the U.S. who responded to the survey are enrolled in these public insurance programs and serve children. While 79 percent of those said they would accept privately insured patients as new patients, only 47 percent responded that they would accept Medicaid or CHIP patients as new patients.
The government report also indicated that physicians have much more difficulty referring Medicaid and CHIP-enrolled children to specialists than they do privately insured children. According to the specialists who responded to the survey, this is because they are underpaid by Medicaid and CHIP and often have to wait a long time to receive payment for their services. Plus, they said they don’t want to deal with the hassle of the paperwork and billing requirements that come with Medicaid and CHIP patients.
“The bigger picture beyond Medicaid and CHIP is that the rate of reimbursement is far lower than that for Medicare, and there is no [financial] incentive [for specialists] to work harder to see more patients,” says Michael Henrickson, MD, a pediatric rheumatologist at Cincinnati Children’s Hospital.
According to a 2007 report from the Health Resources and Services Administration, or HRSA, an agency within the U.S. Health and Human Services, as many as one-third of pediatric rheumatology patients are insured through Medicaid.
But the problem for children with arthritis – low income or otherwise – goes deeper than insurance status. Approximately 294,000 children in the U.S. have arthritis or another rheumatologic condition, according to a 2007 study from the Centers for Disease Control and Prevention. But the HRSA report estimates that there are fewer than 200 certified pediatric rheumatologists practicing in the country. It estimates that at least 337 pediatric rheumatologists are needed to meet patient care needs – a 75 percent increase over current numbers.
Leave a Comment