Insurance Differences and the Resulting Effects on Patient Care

Insurance Differences and the Resulting Effects on Patient Care

Medicaid vs. Private Insurance 2

Insurance Differences and the Resulting Effects on Patient Care

The discussion between private insurance and Medicaid is an ongoing debate. The number of physicians accepting forms of state-funded insurance is decreasing as the gap between those who can and cannot afford private insurance is growing. The amount of research regarding this problem is prominent; however, most of the research is conducted from the physician’s viewpoint, and does not leave much focus for the nursing aspect. Therefore, the question of whether or not patients with private insurance receive a better quality of care as opposed to their counterparts receiving public, state-funded insurance deserves further investigation.

Research regarding this topic is plentiful and covers a vast area of patient care. Pediatric insurance coverage is an area of utmost importance because children require attentive medical care to help ensure a healthy development. Three articles covering three different areas of pediatric insurance differences are discussed in the literature review. One article focuses on the length of time for patients with private insurance to get an appointment with an orthopedic surgeon versus those with Medicaid. Another article analyzes how well primary care providers (PCPs) and specialists communicate. This article focused on insurance status as an end result, as insurance was not originally designated as a variable. Finally, a third article discussed the access to care in the rural setting depending on insurance status.

According to Clemens et al. (2001), the Medicaid system is implemented at the federal level; however, each state determines the reimbursement rates for various medical situations. The ability of each individual state to properly allocate funds to medical

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reimbursement has a significant effect on the accessibility to care for individuals with Medicaid (Clemens et al., 2001). Because reimbursement rates tend to be so much lower than private insurance reimbursement, patients have to travel greater distances in order to find medical care. Arcury et al. (2003) states these distances can be even greater if the child needs the expertise of a specialist as opposed to that of a PCP. Furthermore, research by Clemens et al. (2001) indicates that physicians’ offices will schedule appointments for patients with Medicaid further out than their private insurance counterparts. Mazor et al. (2006) hypothesized that lack of communication from PCPs to specialists could be a result of lower Medicaid reimbursements. PCPs that accept Medicaid patients must see a larger number of patients in order to receive adequate reimbursements to cover their operating costs. This leads to overworked physicians, and as the number of referrals increases, the communication with specialists lags behind.

While previous studies have indicated that Medicaid patients are more likely to miss appointments and be noncompliant in their treatment plans, neither of these findings factored into the research of the selected studies. All of the research conducted and included in this literature review strengthened existing research. Very few findings were unexpected and those primarily dealt with rural access to health care in minority populations. Further research is needed to understand the reasoning for this data (Acury et al., 2003).

While the implications of the research primarily benefits physicians, there is also important implications for nurses. For whatever reason, research suggests that Medicaid patients are not receiving the same access to quality health care as their privately insured

Medicaid vs. Private Insurance