Lack of insurance hinders follow-up appointments

In a project funded by the Henry J. Keiser Family Foundation and a grant from the Agency for Healthcare Research and Quality – which funded Dr. Brent R. Asplin’s work – the research examined access to follow-up appointments according to insurance status in nine U.S. cities from May 2002 to February 2003.

Asplin, of Regions Hospital and HealthPartners Research Foundation in St. Paul, Minn., and colleagues contacted 499 ambulatory clinics, identifying themselves as new patients who had been seen in a hospital emergency department and needed an urgent follow-up appointment within one week.

Callers read from one of three clinical scenarios, requiring follow-up for pneumonia, hypertension or possible ectopic pregnancy.

Each clinic was called twice by the same research assistant, using the same scenario but reporting different insurance status.

Of the 499 clinics contacted, 430 completed the study protocol. Of the 860 total calls, 406, or 47.2 percent were offered appointments within a week. Of the 430 calls in which private insurance coverage was indicated, 277, or 64.4 percent were offered appointments within a week.

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 versus 25.1 percent. Researchers found no difference in the appointment rates between callers with private insurance and those uninsured, but willing to pay cash for the entire visit fee. The typical charge would have been about $100.

However, the study’s authors did note that while 98 percent of the clinics contacted for the study screened callers to determine insurance status, only 28 percent attempted to determine the severity of the caller’s condition.

U.S. residents will make approximately 114 million visits to hospital emergency departments in 2005, and more than 80 percent will be treated and discharged with a recommendation for follow-up care.

However, many patients, both insured and uninsured, have reported problems making timely follow-up appointments.

“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 hospitalization,” the authors wrote in the study.