Doctors Reject Insured Patients on Low Payments, Study Says

Doctors Turn Away Insured Patients on Low Payments
Dr. Emlyn Louis speaks with Julia Herrera as he examines her at the Broward Community & Family Health Center in Pompano Beach, Florida. Photographer: Joe Raedle/Getty Images

U.S. doctors are turning away an increasing number of patients, including those with private insurance, according to a study in the Archives of Internal Medicine.

Physicians were willing to accept about 88 percent of patients who had private insurance in 2008, down from 93 percent in 2005, the study released today found. Patients in Medicare, the U.S. health insurance program for the elderly and disabled, also had a harder time finding a doctor. About 93 percent were accepted by physicians in 2008, down from 96 percent in 2005.

The drop in doctors willing to take private insurance was caused by low payments for services as well as administrative difficulties, said Dr. Tara Bishop, an assistant professor of public health at Weill Cornell Medical College in New York.

“At a moment when the country is poised to achieve near-universal coverage, patients’ access to care could be a casualty of the collision between the medical profession and the insurance industry,” Bishop, the lead author of the study, said in a statement.

The health-care overhaul signed into law in March 2010 requires people to buy private insurance policies and provides tax subsidies to help with the purchases. The Congressional Budget Office projects it will expand medical coverage to 24 million people.

The U.S. government is considering its own assessment of access to physicians under a “secret shopper” program that would have surveyors contact doctors’ offices trying to get appointments. Jay Carney, a White House spokesman, said at a briefing with reporters the plan is still being reviewed and that similar approaches have been used by past administrations.

Coverage Plans

In 2009, 57 percent of Americans younger than age 65 got health coverage through work, and 20 percent were on Medicaid or other public insurance programs, according to the Menlo Park, California-based Kaiser Family Foundation.

Patients in Medicaid, the joint U.S.-state health program for the poor, had more difficulty than privately insured or Medicare patients in finding a doctor who would take their coverage, the study found.

While the drop in doctors’ willingness to see patients was small, the expansion of insurance coverage under the health law in 2014 is likely to mean many more people will be trying to see physicians, said Leighton Ku, a professor of health policy at George Washington University. The newly insured will be seeking medical care while the number of doctors will stay relatively the same, he said.

Finding a Physician

“It may well indicate that there are going to be some problems,” Ku said in a telephone interview from Washington. “If you see a big surge in demand in 2014 and not enough doctors taking patients, then we have a recipe for a bad situation,” he said.

Without more doctors joining the workforce or putting in longer hours, U.S. health-care providers may have to rely more on nurses and physicians assistants to provide care, Ku said.

A reason that doctors may be accepting fewer patients is that some insurers have shrunk the network of doctors and hospitals they contract with to improve quality and value, said Robert Zirkelbach, a spokesman for America’s Health Insurance Plans. The group is the Washington trade association for health insurers led by Indianapolis-based WellPoint Inc. and Philadelphia-based Cigna Corp.

“Health plans are selective in who they contract with, so that their members have access to doctors and hospitals that provide safe, high quality care,” Zirkelbach said in a telephone interview.

While insurers have increased their scrutiny of medical claims to try to keep down costs, doctors also must do a better job of filing requests for payment correctly and on time. Too few use electronic records, and many file claims late or inaccurately, he said.

“It’s a two-way street,” Zirkelbach said.

Before it's here, it's on the Bloomberg Terminal. LEARN MORE