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Access to Primary, Mental Health, and Specialty Care: a Comparison of Medicaid and Commercially Insured Populations in Oregon
Open accessAbstract
Objective To describe how access to primary and specialty care differs for Medicaid patients relative to commercially insured patients, and how these differences vary across rural and urban counties, using comprehensive claims data from Oregon. Design Cross-sectional study of risk-adjusted access rates for two types of primary care providers (physicians; nurse practitioners (NPs) and physician assistants (PAs)); four types of mental health providers (psychiatrists, psychologists, advanced practice NPs or PAs specializing in mental health care, behavioral specialists); and four physician specialties (obstetrics and gynecology, general surgery, gastroenterology, dermatology). Participants 420,947 Medicaid and 638,980 commercially insured adults in Oregon, October 2014-September 2015. Outcome Presence of any visit with each provider type, risk-adjusted for sex, age, and health conditions. Results Relative to commercially insured individuals, Medicaid enrollees had lower rates of access to primary care physicians (- 11.82%; CI - 12.01 to - 11.63%) and to some specialists (e.g., obstetrics and gynecology, dermatology), but had equivalent or higher rates of access to NPs and PAs providing primary care (4.33%; CI 4.15 to 4.52%) and a variety of mental health providers (including psychiatrists, NPs and PAs, and other behavioral specialists). Across all providers, the largest gaps in Medicaid-commercial access rates were observed in rural counties. The Medicaid-commercial patient mix was evenly distributed across primary care physicians, suggesting that access for Medicaid patients was not limited to a small subset of primary care providers. Conclusions This cross-sectional study found lower rates of access to primary care physicians for Medicaid enrollees, but Medicaid-commercial differences in access rates were not present across all provider types and displayed substantial variability across counties. Policies that address rural-urban differences as well as Medicaid-commercial differences-such as expansions of telemedicine or changes in the workforce mix-may have the largest impact on improving access to care across a wide range of populations.
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A recent study found that Medicaid patients face more challenges in accessing specialty care than commercially insured patients.
“A recent study found that Medicaid patients face more challenges in accessing specialty care than commercially insured patients. 18”
From The use of an artificial intelligence platform OpenEvidence to augment clinical decision-making for primary care physicians (2025) · cites this paper as [18]
The Results report lower access for Oregon Medicaid enrollees to some physician specialties, notably obstetrics and gynecology and dermatology. The claim is broader than the finding: access to general surgery was similar across insurance groups, and access to some mental health providers was higher for Medicaid enrollees. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIn the same study, access to nurse practitioners and physician assistants (NPPAs) providing primary care was higher than that of PCPs.
“In the same study, access to nurse practitioners and physician assistants (NPPAs) providing primary care was higher than that of PCPs. 18”
From The use of an artificial intelligence platform OpenEvidence to augment clinical decision-making for primary care physicians (2025) · cites this paper as [18]
The Results report that, relative to commercially insured patients, Medicaid patients had higher access to NPs and PAs providing primary care but lower access to primary care physicians. That compares insurance groups within each provider type; it does not establish that access to NPs and PAs was higher than access to physicians overall. (LLM, conf=0.86)
Experimental — accuracy not yet measuredIn this study, Medicaid enrollees had lower access rates to PCPs and some specialists, with the largest gaps observed in rural countries.
“In this study, Medicaid enrollees had lower access rates to PCPs and some specialists, with the largest gaps observed in rural countries. 18”
From The use of an artificial intelligence platform OpenEvidence to augment clinical decision-making for primary care physicians (2025) · cites this paper as [18]
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Cited by
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Hurt, R. T., Stephenson, C. R., Gilman, E. A., Aakre, C. A., Croghan, I. T., Mundi, M. S., Ghosh, K., & Edakkanambeth Varayil, J. (2025) · Journal of Primary Care & Community Health · doi:10.1177/21501319251332215 · Cited by 78
“18 In the same study, access to nurse practitioners and physician assistants (NPPAs) providing primary care was higher than that of PCPs. 18 A tool such as OE that can help with a wide range of common (as demonstrated by the current study) and complex PCC questions could fill the gap between…”
Metadata
- Authors
- McConnell, K. J., Charlesworth, C. J., Zhu, J. M., Meath, T. H. A., George, R. M., Davis, M. M., Saha, S., & Kim, H.
- Affiliations
- Oregon Health & Science University (US)
- Corresponding author
- McConnell, K. John
- ORCID
- Venue
- Journal of General Internal Medicine
- Published
- 2019-10-28
- Volume
- 35
- Issue
- 1
- Pages
- 247-254
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC6957609
- OpenAlex
- W2982332500
- Cited by
- 33
- References
- 0
- Citations by year
- 2026: 4 · 2025: 8 · 2024: 3 · 2023: 8 · 2022: 7 · 2021: 1 · 2020: 2
- FWCI
- 3.12
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of General Internal Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Cancer Institute (K07CA211971)
- National Institute on Minority Health and Health Disparities (R01MD011212)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Health Sciences › Medicine › Family Practice › Primary Care and Health Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Global Health Workforce Issues
- Keywords
- Medicaid, private insurance, health care access, primary care, mental health services, specialist care, nurse practitioners, physician assistants, urban-rural differences, health care disparities, Oregon
- MeSH terms
- Adult, Cross-Sectional Studies, Female, Health Services Accessibility, Humans, Medicaid, Mental Health, Oregon, Pregnancy, Primary Health Care, United States
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