Brent R. Asplin, M.D., M.P.H., from Regions Hospital and Health Partners Research Foundation, St. Paul, Minn., and colleagues examined the access to follow-up appointments according to insurance status in nine U.S. cities from May 2002 to February 2003. Eight research assistants called 499 ambulatory clinics, identifying themselves as new patients who had been seen in an ED and needed an urgent follow-up appointment within one week. Callers read from one of three clinical scenarios requiring follow-up for either pneumonia, hypertension or possible ectopic pregnancy. The same research assistant called each clinic twice using the same scenario but reporting different insurance status.

47.2 percent of 860 total callers and 64.4 percent of 430 privately insured callers were offered appointments within a week. Callers who said they had private health insurance were more likely to receive appointments than those claiming to have Medicaid coverage (63.6 percent vs. 34.2 percent).

Those claiming to have private insurance also had higher appointment rates than those who reported having no insurance but offered to pay $20 and arrange payment of balance (65.3 percent vs. 25.1 percent).

“Regardless of insurance status, 98 percent of clinics contacted in this study screened callers to determine insurance status, whereas only 28 percent attempted to determine the severity of the caller’s condition,” the authors write.

“These study findings suggest that reported insurance status influences access to follow-up appointments for patients with conditions requiring urgent ambulatory follow-up care,” the authors write. “Although the ultimate consequences of these access barriers are not known, they may result in patients’ delaying needed follow-up care, risking adverse outcomes, or requiring additional emergency care or hospitalisation.”; Source: American Medical Association (AMA)