No Evidence That Primary Care Physicians Offer Less Care To Medicaid, Community Health Center, Or Uninsured Patients

Abstract

The Affordable Care Act increases US investment in Medicaid and community health centers, yet many people believe that care in such safety-net programs is substandard. Using data from more than 31,000 visits to primary care physicians in the period 2006-10, we examined whether the length or content of a visit was different for safety-net patients-those insured by Medicaid, those who are uninsured, and those seen in a community health center-compared to patients with private insurance. We found no significant differences in the average length of a primary care visit or in the likelihood of a patient's receiving preventive health counseling. Medicaid patients received more diagnostic and treatment services, and uninsured patients received fewer services, compared to privately insured patients, but the differences were small. This analysis indicates that length and content of primary care visits are comparable for safety-net and other patients. The main factors that contribute to differences in visit length and content are patients' health needs and the type of visit involved.

Time spent with patients by physicians, nurse practitioners, and physician assistants in community health centers, 2006–2010

“…Other factors can affect the time actually spent, including longer appointment blocks that some clinics use for new patients and those scheduled for yearly check-ups or complex visits. Still, the results of our study and others 19,33 find that visit length for all provider types averages very near twenty minutes per patient. When patient needs require additional time, providers typically schedule return appointments to address those needs.…”

“…A recent analysis of primary care visits by Bruen and colleagues using NAMCS data found that care of CHC patients was similar to that of patients in other settings with regard to content of care and time spent per visit. 33 Like the Bruen group, we found that the major determinants of time spent with patients were their health needs and the type and quantity of care provided. The organization of care and characteristics of providers are different in CHCs than in the private sector, and these differences might also limit generalizability of our findings.…”

“…If physicians, NPs and PAs are all given the same fixed amount of time to see each patient, this could influence the amount of time that providers spend with a patient. 33 Visits for returning patients are often scheduled for 15 minute or 20 minute time slots. Other factors can affect the time actually spent, including longer appointment blocks that some clinics use for new patients and those scheduled for yearly check-ups or complex visits.…”

Waiting Room Education in a Community Health System: Provider Perceptions and Suggestions

“…As demand for care grows, time spent in the waiting room has come to exceed time spent with a physician on average [5,19]. While this fact is frustrating for providers and patients alike, it also challenges those in the system to rethink the waiting room space and time, to imagine new possibilities for it, and to incorporate it into the system of care provision as a tool, not a necessary evil.…”

Effect of Gaining Insurance Coverage on Smoking Cessation in Community Health Centers: A Cohort Study

“…5,6 Community health centers (CHCs) provide primary care to medically underserved and vulnerable populations regardless of ability to pay. 7 Most CHC patients are uninsured or Medicaid recipients, and have incomes below the FPL. 8 CHCs are well positioned to identify patients who smoke and to provide them with smoking cessation assistance.…”