Primary care physicians spend just as much time during office visits with so-called safety-net patients as they do with those who have private insurance, according to a new study published in the September issue of Health Affairs(content.healthaffairs.org).
The study was based on National Ambulatory Medical Care Survey data from 2006-10 and included 31,825 observed primary care visits with nonelderly patients in its final models. Researchers compared visit length among patients who had Medicaid, no insurance or private insurance. Insurance type did not significantly affect visit length or the level of preventive health counseling provided, the study concluded.
"One of the motivations for the study was that we've heard many arguments against Medicaid expansions, and a general refrain is that Medicaid is broken or inferior or Medicaid coverage is not as good as private insurance," said Brian Bruen, study author and lead research scientist in health policy at George Washington University. "Our question was: Once the patient is in front of the physician, is there really any difference in how the physician treats the patient?"
The study did not address access to care, only how a physician treats a patient when the patient is in the exam room. However, the location of the visit -- whether it was a community health center or another office -- had no impact on length of visit, the study found.
Overall, the average time patients spent with a U.S. primary care physician during the study period was 18.53 minutes, with a specific breakdown as follows:
- patients with private insurance spent an average of 18.46 minutes with a physician,
- patients who had Medicaid spent an average of 17.95 minutes with a physician,
- patients who self-paid spent an average of 19.82 minutes with a physician and
- patients with other types of insurance spent an average of 19.53 minutes with a physician.
Physician visits held in community health centers were, on average, 18.01 minutes long, and those held in other office settings were, on average, 18.55 minutes long. On average, new patient visits were more than three minutes longer than visits with established patients.
The study did find small differences between insurance types when it came to diagnostic and treatment services. Uninsured patients received slightly fewer diagnostic and treatment services than their insured counterparts, and patients who had Medicaid received slightly more services.
Half of the office visits in the study were with family physicians or general practice physicians, Bruen said. The other half included pediatricians and internists. "We did some sensitivity testing and found no significant differences between the results whether (the specialties) were grouped or separate," he said.
"Our findings suggest there should be more uniformity in payment across all payer types," said Bruen. "When patients have access to primary care, they receive comparable care regardless of the type of insurance they have. Physicians should also get comparable pay for comparable effort."
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