Safety-Net Patients Receive Comparable Care

SPHHS research finds no evidence that Medicaid and safety-net patients receive less care than those insured.

September 11, 2013

Medicine Healthcare

A new study by researchers at the George Washington University School of Public Health and Health Services (SPHHS) challenges claims that patients who rely on safety-net health care systems receive substandard care.

The study, “No Evidence That Primary Care Physicians Offer Less Care to Medicaid, Community Health or Uninsured Patients,” appears in the September issue of the journal Health Affairs. Research was supported by the Geiger/Gibson RCHN Community Health Foundation Research Collaborative.

Critics have long argued that stressors on Medicaid and the safety-net system have led to substandard or second-class care. SPHHS researchers analyzed data from the National Ambulatory Medical Care Survey, which includes samples of physician office visits from all over the nation. The researchers looked at the time doctors spent with patients, the volume of diagnostic and treatment services provided and whether preventive health counseling was offered during visits.

“The findings refute the belief that primary care doctors deliver less care to the nation’s poor,” said Brian K. Bruen, a lead author of the study and a lead research scientist in the Department of Health Policy at SPHHS.

Researchers examined data from more than 31,000 primary care visits from 2006 to 2010. Dr. Bruen explained that when compared to visits by patients with private insurance, no findings indicated primary care doctors “skimped on the time they spent with uninsured or other safety-net patients, or the amount of care provided during those visits.”

On average, primary care physicians spent 18 minutes with each patient. Primary care doctors spent more time with new patients than with established patients. They also spent more time with patients who had more serious medical problems. The authors found no meaningful differences by type of patient insurance in either duration of the physician visit or the type and scope of services rendered.

“We examined whether the pressures of trying to provide care to the uninsured or to patients with Medicaid might lead physicians to take short cuts,” said co-author Leighton Ku, the director of the Center for Health Policy Research at SPHHS. “This study indicates that most primary care physicians make medical decisions based on their patients’ health needs, not their insurance status.”

The study also found no evidence that the length of the typical primary care visit varied by practice type or site. Patients receiving care from community health centers spent as much time with the physician as those in private doctors’ offices or other settings.

While the findings suggest the nation’s safety-net systems provide care comparable to that offered in other settings, the authors note that the findings are not intended to suggest that there is no room for improvement. Ensuring both access and quality of care for all patients remains an essential priority for the future, the authors said.

“This study shows that primary care doctors working in community health centers and other settings provide all patients with comparable care, irrespective of insurance status,” said Feygele Jacobs, president and CEO of the RCHN Community Health Foundation. “Community health centers currently provide care to more than 22 million people and will need continued support in order to expand access and enhance quality under health reform.”