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More Wait Time: The Impact of ACA Implementation on Patient Access

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February 18th, 2014

Female doctor shaking a hand

Achieving access to services for those who need care is on the mind of all health systems around the country.

Last fall, a health issue led me to seek consultation from my primary care physician.  While attempting to schedule his first available appointment, I discovered that it would be a month and half before I could visit with him.  Feeling like my health issue required more immediate attention, I sought assistance from a friend who has ties to the medical community and was able to secure an appointment with a different family practitioner within the week.  Without that friend, I don’t think I could have arranged such an immediate doctor’s visit.  After I pondered this experience, I realized that experiences like mine were likely not unique and many people are unable to get needed medical appointments within a short time frame.  And on that particular occasion, I was lucky to get one.

Segments of our country’s population experience issues accessing health care, some more than others.  My experience has made me more aware of these issues, both those that we face currently and those that we will experience in the future.  The notions of a provider shortage in the U.S. and how our country lacks physician manpower to take care of its citizenry are not new tales to be told in the health care community.  One of the biggest worries with implementing the ACA was how increased access to care, through Medicaid expansion and subsidized coverage on the exchanges, would exacerbate one’s ability to see a physician in a timely manner.  With the ACA in full implementation mode (2014 opened the flood-gates for Medicaid expansion and insurance exchange usage), it will be interesting to see how access will be affected over the course of the next year and beyond, especially if a requisite increase to physician supply isn’t achieved.

According to a recent report by Merritt Hawkins, the national cumulative physician wait time for 15 of the largest metropolitan areas was 19.5 days to see a family practice physician and 18.5 days to see a specialist.  However, depending on location, wait times varied from five days (Dallas) to 66 days (Boston) for a family practice physician and 10.2 days (Dallas) to 45.4 days (Boston).  It should be noted that MA has a 3% uninsured rate while TX has the lowest amount of Medicaid enrollment to eligibility in the country.  Furthermore, Boston had the highest rate of Medicaid acceptance (73%), while Dallas had the lowest (23%).

Several states appear to be having a high level of activity with expansion and exchange implementation.  Some of these states include California, Colorado, Connecticut, Hawaii, Maryland, Massachusetts, Minnesota, New York, Oregon, and Vermont.  California and New York are having success in enrolling folks into Medicaid and onto the exchanges, relative to other states across the country.  Overall, the effort and results to enroll the uninsured hasn’t been too fruitful, yet.  As we witness implementation moving forward with Medicaid expansion and exchanges, it will be interesting to see which of these states, if any, will experience dramatic negative consequences to increasing access, including longer wait times and/or less providers accepting Medicaid patients.

We can only hope that more covered lives won’t necessarily mean less access to care and that a steady stream of more “insureds” doesn’t impede our ability to see our physician in the future.

 

Sources:

PR NewsWire: Survey: Wait Times For A Doctor Appointment Longest in Boston, Shortest in Dallas, 1-29-14

Merritt Hawkins: 2014 Physician Appointment Wait Times

Becker’s Hospital Review: 10 Most Involved States in PPACA Implementation, 1-31-14

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