Insurance Status and Access to High Quality Cancer Care: An Audit Study Proposal

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Event Type: 
Seminar Series
Date and Time: 
Monday, April 18, 2016
2:00 pm – 3:30 pm

Approximately 12 million individuals enrolled in Medicaid between July-Sept 2013 and January 2015, many of them adults newly eligible for Medicaid under the ACA’s low-income expansion (ASPE 2015). Unfortunately, Medicaid coverage does not always confer health care access. Low payment rates mean many providers will either not accept Medicaid patients or limit the number of slots allocated to these patients. Numerous audit studies show that Medicaid patients, like the uninsured, are much less likely to get timely  appointments for primary care than similar patients with private insurance (Asplin et al. 2005; Saloner et al. 2014; Rhodes et al. 2014) and that access is improved when fees increase

(Polsky et al. 2015). Less well understood is how Medicaid or uninsurance affects access to high quality specialty care. The goal of this study is to estimate the effect of insurance status (Medicaid vs. private insurance vs. uninsurance/self-pay) on access to high quality mammography screening and follow-up treatment. Like studies of access to primary care, we will adopt an audit study or simulated patient experience methodology that randomly assigns insurance status to fictitious patient callers seeking mammogram appointments or follow-up consultations with a breast surgeon. Access will be defined as appointment availability (e.g., likelihood of an appointment within 2 weeks) and wait-times for an appointment.

Quality will be measured using a special designation from the American College of Radiology for mammography and either the National Cancer Institute or the American College of Surgeons for follow-up consultations.  Our hypothesis is that access to high quality care is limited for Medicaid and uninsured patients relative to privately insured individuals. We suspect this will be particularly true for follow-up surgical consultations and in states that have not expanded Medicaid.