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Meta-Analysis
. 2019 Jan-Dec:56:46958019838118.
doi: 10.1177/0046958019838118.

Medicaid Patients Have Greater Difficulty Scheduling Health Care Appointments Compared With Private Insurance Patients: A Meta-Analysis

Walter R Hsiang  1 , Adam Lukasiewicz  1 , Mark Gentry  1 , Chang-Yeon Kim  2 , Michael P Leslie  1 , Richard Pelker  1 , Howard P Forman  1   3 , Daniel H Wiznia  1
Affiliations
Meta-Analysis

Medicaid Patients Have Greater Difficulty Scheduling Health Care Appointments Compared With Private Insurance Patients: A Meta-Analysis

Walter R Hsiang et al. Inquiry. 2019 Jan-Dec.

Abstract

Medicaid patients are known to have reduced access to care compared with privately insured patients; however, quantifying this disparity with large controlled studies remains a challenge. This meta-analysis evaluates the disparity in health services accessibility of appointments between Medicaid and privately insured patients through audit studies of health care appointments and schedules. Audit studies evaluating different types of outpatient physician practices were selected. Studies were categorized based on the characteristics of the simulated patient scenario. The relative risk of appointment availability was calculated for all different types of audit scenario characteristics. As a secondary analysis, appointment availability was compared pre- versus post-Medicaid expansion. Overall, 34 audit studies were identified, which demonstrated that Medicaid insurance is associated with a 1.6-fold lower likelihood in successfully scheduling a primary care appointment and a 3.3-fold lower likelihood in successfully scheduling a specialty appointment when compared with private insurance. In this first meta-analysis comparing appointment availability between Medicaid and privately insured patients, we demonstrate Medicaid patients have greater difficulty obtaining appointments compared with privately insured patients across a variety of medical scenarios.

Keywords: Medicaid; appointments and schedules; health services accessibility; healthcare disparities; insurance; meta-analysis; patient protection and affordable care act; primary health care.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Flow chart of study selection. Source. Author’s selection of studies based on predetermined criteria, 2017. Note. ED = emergency department; VA = veteran affairs.
Figure 2.
Figure 2.
Funnel plot of selected studies. Source. Author’s analysis of 34 audit studies, 2017.
Figure 3.
Figure 3.
The RR and CI of getting an appointment with private insurance compared with Medicaid. Source. Author’s analysis of 34 audit studies, 2017. Note. RR = relative risk; CI = confidence interval.
See this image and copyright information in PMC

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