Molly M Fuentes1, Leah Thompson2, D Alex Quistberg3, Wren L Haaland2, Karin Rhodes4, Deborah Kartin5, Cheryl Kerfeld5, Susan Apkon5, Ali Rowhani-Rahbar6, Frederick P Rivara7. 1. Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA; Seattle Children's Research Institute, Seattle, WA; Harborview Injury Prevention and Research Center, Seattle, WA. Electronic address: molly.fuentes@seattlechildrens.org. 2. Seattle Children's Research Institute, Seattle, WA. 3. Harborview Injury Prevention and Research Center, Seattle, WA. 4. Hofstra Northwell School of Medicine, Office of Population Health, Great Neck, NY. 5. Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA. 6. Harborview Injury Prevention and Research Center, Seattle, WA; Department of Epidemiology, University of Washington School of Public Health, Seattle, WA. 7. Seattle Children's Research Institute, Seattle, WA; Harborview Injury Prevention and Research Center, Seattle, WA; Department of Epidemiology, University of Washington School of Public Health, Seattle, WA; Department of Pediatrics, University of Washington School of Medicine, Seattle, WA.
Abstract
OBJECTIVE: To identify insurance-based disparities in access to outpatient pediatric neurorehabilitation services. DESIGN: Audit study with paired calls, where callers posed as a mother seeking services for a simulated child with history of severe traumatic brain injury and public or private insurance. SETTING: Outpatient rehabilitation clinics. PARTICIPANTS: Sample of rehabilitation clinics (N=287): 195 physical therapy (PT) clinics, 109 occupational therapy (OT) clinics, 102 speech therapy (ST) clinics, and 11 rehabilitation medicine clinics. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Acceptance of public insurance and the number of business days until the next available appointment. RESULTS: Therapy clinics were more likely to accept private insurance than public insurance (relative risk [RR] for PT clinics, 1.33; 95% confidence interval [CI], 1.22-1.44; RR for OT clinics, 1.40; 95% CI, 1.24-1.57; and RR for ST clinics, 1.42; 95% CI, 1.25-1.62), with no significant difference for rehabilitation medicine clinics (RR, 1.10; 95% CI, 0.90-1.34). The difference in median wait time between clinics that accepted public insurance and those accepting only private insurance was 4 business days for PT clinics and 15 days for ST clinics (P≤.001), but the median wait time was not significantly different for OT clinics or rehabilitation medicine clinics. When adjusting for urban and multidisciplinary clinic statuses, the wait time at clinics accepting public insurance was 59% longer for PT (95% CI, 39%-81%), 18% longer for OT (95% CI, 7%-30%), and 107% longer for ST (95% CI, 87%-130%) than that at clinics accepting only private insurance. Distance to clinics varied by discipline and area within the state. CONCLUSIONS: Therapy clinics were less likely to accept public insurance than private insurance. Therapy clinics accepting public insurance had longer wait times than did clinics that accepted only private insurance. Rehabilitation professionals should attempt to implement policy and practice changes to promote equitable access to care.
OBJECTIVE: To identify insurance-based disparities in access to outpatient pediatric neurorehabilitation services. DESIGN: Audit study with paired calls, where callers posed as a mother seeking services for a simulated child with history of severe traumatic brain injury and public or private insurance. SETTING:Outpatient rehabilitation clinics. PARTICIPANTS: Sample of rehabilitation clinics (N=287): 195 physical therapy (PT) clinics, 109 occupational therapy (OT) clinics, 102 speech therapy (ST) clinics, and 11 rehabilitation medicine clinics. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Acceptance of public insurance and the number of business days until the next available appointment. RESULTS: Therapy clinics were more likely to accept private insurance than public insurance (relative risk [RR] for PT clinics, 1.33; 95% confidence interval [CI], 1.22-1.44; RR for OT clinics, 1.40; 95% CI, 1.24-1.57; and RR for ST clinics, 1.42; 95% CI, 1.25-1.62), with no significant difference for rehabilitation medicine clinics (RR, 1.10; 95% CI, 0.90-1.34). The difference in median wait time between clinics that accepted public insurance and those accepting only private insurance was 4 business days for PT clinics and 15 days for ST clinics (P≤.001), but the median wait time was not significantly different for OT clinics or rehabilitation medicine clinics. When adjusting for urban and multidisciplinary clinic statuses, the wait time at clinics accepting public insurance was 59% longer for PT (95% CI, 39%-81%), 18% longer for OT (95% CI, 7%-30%), and 107% longer for ST (95% CI, 87%-130%) than that at clinics accepting only private insurance. Distance to clinics varied by discipline and area within the state. CONCLUSIONS: Therapy clinics were less likely to accept public insurance than private insurance. Therapy clinics accepting public insurance had longer wait times than did clinics that accepted only private insurance. Rehabilitation professionals should attempt to implement policy and practice changes to promote equitable access to care.
Authors: Beth S Slomine; Melissa L McCarthy; Ru Ding; Ellen J MacKenzie; Kenneth M Jaffe; Mary E Aitken; Dennis R Durbin; James R Christensen; Andrea M Dorsch; Charles N Paidas Journal: Pediatrics Date: 2006-03-13 Impact factor: 7.124
Authors: Megan Moore; Nathalia Jimenez; Ali Rowhani-Rahbar; Margaret Willis; Kate Baron; Jessica Giordano; Deborah Crawley; Frederick P Rivara; Kenneth M Jaffe; Beth E Ebel Journal: Am J Phys Med Rehabil Date: 2016-03 Impact factor: 2.159
Authors: Sofia B Chaudhry; Eric S Armbrecht; Yoon Shin; Sarah Matula; Charles Caffrey; Reena Varade; Lisa Jones; Elaine Siegfried Journal: J Am Acad Dermatol Date: 2013-03-07 Impact factor: 11.527
Authors: Janessa M Graves; Jessica L Mackelprang; Megan Moore; Demetrius A Abshire; Frederick P Rivara; Nathalia Jimenez; Molly Fuentes; Monica S Vavilala Journal: Health Serv Res Date: 2018-12-03 Impact factor: 3.402
Authors: Matthew R Powell; Allen W Brown; Danielle Klunk; Jennifer R Geske; Kamini Krishnan; Cassie Green; Thomas F Bergquist Journal: J Clin Psychol Med Settings Date: 2019-12
Authors: Molly M Fuentes; Megan Moore; Qian Qiu; Alex Quistberg; Matthew Frank; Monica S Vavilala Journal: J Racial Ethn Health Disparities Date: 2018-10-01