Trouble getting a doctor’s appointment may drive Medicaid enrollees to opt for the ER

The expansion of Medi-Cal, California’s Medicaid program, gave millions of low-income Californians access to health insurance, but this study conducted in Northern California found that new patients may have to wait up up to a month for an appointment with a participating primary care provider, depending on their county of residence. It is not uncommon for Medi-Cal enrollees to visit emergency rooms if they require more immediate care.

This study looks at the variation between contiguous counties in the availability of new patient primary care appointments for Medi-Cal enrollees and at the correlation between primary care access and rates of Medi-Cal patients’ emergency room usage. Researchers found that counties where it was more difficult to schedule new patient primary care appointments had higher rates of emergency room usage by Medi-Cal patients. This places a greater strain on already overburdened emergency departments and drives up health care costs overall.

How California’s challenges compare with those faced by other states that have expanded Medicaid eligibility under the Affordable Care Act is unclear, though the data suggest that “adequate access to primary care will begin to improve health outcomes and control costs among beneficiaries of Medicaid expansion.”

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Primary Care Access to New Patient Appointments for California Medicaid Enrollees: A Simulated Patient Study

Joy Melnikow, MD, MPH, et al

University of California, Davis, Center for Healthcare for Policy and Research, Sacramento, California


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