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Cited by 331Healthcare Policy and ManagementChild and Adolescent HealthHealthcare Systems and Reforms

Auditing Access to Specialty Care for Children with Public Insurance

Open access
Bisgaier, Joanna, Rhodes, Karin V.·2011·New England Journal of Medicine
DOI 10.1056/nejmsa1013285
Open this paper in CoChat — free accountOpen PDF

Abstract

BACKGROUND: Health care reform has expanded eligibility to public insurance without fully addressing concerns about access. We measured children's access to outpatient specialty care to identify disparities in providers' acceptance of Medicaid and the Children's Health Insurance Program (CHIP) versus private insurance. METHODS: Between January and May 2010, research assistants called a stratified, random sample of clinics representing eight specialties in Cook County, Illinois, which has a high proportion of specialists. Callers posed as mothers of pediatric patients with common health conditions requiring outpatient specialty care. Two calls, separated by 1 month, were placed to each clinic by the same person with the use of a standardized clinical script that differed by insurance status. RESULTS: We completed 546 paired calls to 273 specialty clinics and found significant disparities in provider acceptance of Medicaid-CHIP versus private insurance across all tested specialties. Overall, 66% of Medicaid-CHIP callers (179 of 273) were denied an appointment as compared with 11% of privately insured callers (29 of 273) (relative risk, 6.2; 95% confidence interval [CI], 4.3 to 8.8; P<0.001). Among 89 clinics that accepted both insurance types, the average wait time for Medicaid-CHIP enrollees was 22 days longer than that for privately insured children (95% CI, 6.8 to 37.5; P=0.005). CONCLUSIONS: We found a disparity in access to outpatient specialty care between children with public insurance and those with private insurance. Policy interventions that encourage providers to accept patients with public insurance are needed to improve access to care.

AI snapshot

Written from the paper’s full text.

TL;DR

An audit study of pediatric specialty clinics in Cook County, Illinois, found that callers posing as mothers of publicly insured children were much more likely to be denied appointments than callers reporting private insurance. Even when appointments were offered, publicly insured children waited substantially longer.

Key findings

  • Among 273 specialty clinics and 546 paired calls, 66% of Medicaid-CHIP callers (179 of 273) were denied an appointment versus 11% of privately insured callers (29 of 273) (relative risk, 6.2; 95% CI, 4.3 to 8.8; P<0.001).
  • Disparities were significant across all tested specialties; in matched-pair analysis, 155 discordant pairs (57%) accepted privately insured children but not Medicaid-CHIP enrollees, versus 5 pairs (2%) with the reverse pattern (odds ratio for denial with public insurance, 31.0; 95% CI, 13.0 to 96.8).
  • Among 89 clinics that accepted both insurance types, children with public insurance waited an average of 42 days for an appointment versus 20 days for privately insured children (mean difference, 22.1 days; 95% CI, 6.8 to 37.5; P=0.005).

Methods

  • Audit study conducted January through May 2010 in Cook County, Illinois, using trained callers posing as mothers of pediatric patients with common conditions requiring outpatient specialty care.
  • A stratified random sample of clinics representing eight specialties was called twice by the same caller, separated by 1 month, with only insurance status varied: Illinois Medicaid-CHIP versus Blue Cross Blue Shield private insurance.
  • Outcomes were appointment scheduling and wait time; analyses used relative risks, McNemar’s test for paired calls, exact conditional logistic regression for specialty subanalyses, and paired t-tests for wait-time differences.

Limitations

  • The paper states caution in generalizing beyond the specific specialties and region audited, notes no evidence about inpatient or rural pediatric specialists, and says the study was not powered to identify specific provider or clinic characteristics associated with denials or delays.
  • The paper also states it did not identify causes of interspecialty variation, did not assess cognitive versus procedural/surgical specialists, and did not determine whether the disparities are clinically meaningful for children’s long-term health and safety.
  • The paper notes it assessed only publicly and privately insured children, so access may differ for uninsured children and for adults; evident from the design, the findings are also limited to simulated calls in one urban, specialist-dense county and to one public insurance program and one private insurer.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1056/nejmsa1013285

Cites

41 of 41 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

4 of 32 cited sources checked · 0 supported · 0 flagged · accuracy not yet measured

  • Premisecitation

    Children covered by Medicaid-CHIP may face greater barriers to specialist care as a result of fewer resources within their families, including lower levels of income, education, language proficiency, and health literacy.

    “Children covered by Medicaid-CHIP may face greater barriers to specialist care as a result of fewer resources within their families, including lower levels of income, education, language proficiency, and health literacy.14”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites [14] source

      The Results (Information and Access to Specialty Health Care Services; page unavailable) report that children in poorer families were less likely to use specialist physician services, and the Discussion links lower income and education to reduced awareness of needed services. But the paper says public and private insurance were equally effective for specialist access; it does not establish greater barriers specifically for Medicaid–CHIP enrollees or assess language proficiency. Lower literacy is mentioned as a possible reason for targeted outreach, not demonstrated as a specialist-care barrier. (LLM, conf=0.88)

      Experimental — accuracy not yet measured
  • Premisecitation

    Subsequent audit studies did not sufficiently examine physicians' willingness to provide needed specialty care for publicly insured children.

    “Subsequent studies in which this approach was used did not sufficiently examine physicians' willingness to provide needed specialty care for publicly insured children.7,13,21,22”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites [7] source
    • cites [13] source
    • cites [21] source

      The Abstract and Measurement of Insurance Adequacy section describe a survey-based analysis of children’s insurance and access to specialist care, not an audit study. The paper does not measure physicians’ willingness to treat publicly insured children, but it cannot substantiate the claim about subsequent audit studies as a group. (LLM, conf=0.83)

      Experimental — accuracy not yet measured
  • Findingown data

    Across all tested specialties, children with Medicaid-CHIP were significantly more likely to be denied an appointment than privately insured children.

    “We completed 546 paired calls to 273 specialty clinics and found significant disparities in provider acceptance of Medicaid-CHIP versus private insurance across all tested specialties.”
    • Also stated in: § Outcomes · plain
      “All relative risks (when calculable) and exact conditional logistic-regression analyses showed that, across all tested specialties, children with Medicaid-CHIP were significantly more likely to be denied an appointment than privately insured children.”
    • Also stated in: § Discussion · plain
      “These results held across all audited specialties.”
    Quote in the paperSubstantial claim
  • Findingown data

    For all specialties combined, the relative risk of appointment denial with public insurance versus private insurance was 6.2 (95% CI, 4.3 to 8.8).

    “6.2 (4.3-8.8)”
    Quote in the paperSubstantial claim
  • Findingown data

    Among 89 clinics that accepted both insurance types, the average wait time for Medicaid-CHIP enrollees was 22 days longer than that for privately insured children (95% CI, 6.8 to 37.5; P=0.005).

    “Among 89 clinics that accepted both insurance types, the average wait time for Medicaid-CHIP enrollees was 22 days longer than that for privately insured children (95% CI, 6.8 to 37.5; P = 0.005).”
    • Also stated in: § Outcomes · plain
      “On average, children with public insurance waited 42 days for an appointment with a specialist, whereas privately insured children waited 20 days (mean difference, 22.1 days; 95% CI, 6.8 to 37.5; P = 0.005).”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 24
  • May combine two claims. 15

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductcitation

    Sample-size calculations before the study indicated that 20 clinics would provide 80% power to detect a 34% difference and 32 clinics would be needed to detect a 20% difference in the rate of clinics accepting public versus private insurance, at an alpha level of 0.05.

    “Sample-size calculations for McNemar's test before the study were based on previous data from audit studies.21 We calculated that a sample of 20 clinics would provide 80% power to detect a 34% difference and that 32 clinics would be needed to detect a 20% difference in the rate of clinics accepting public versus private insurance, at an alpha level of 0.05.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [21] source

      The citation is attached to the statement that the sample-size calculations used previous audit-study data; the following sentence presents the power calculations as the citing authors’ own. The cited paper’s Statistical Analysis section describes analyses of a national survey of children, not an audit of clinics, and our copy provides no audit-study data or clinic sample-size calculations (searched for McNemar’s test, clinic acceptance, and the stated power figures). (LLM, conf=0.76)

      Experimental — accuracy not yet measured

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The study did not assess whether acceptance of public insurance varies between specialists who provide cognitive consultations and procedural or surgical specialists.

    “Nor did we assess whether acceptance of public insurance varies between specialists who provide cognitive consultations and procedural or surgical specialists, who may be more dependent on their affiliated hospitals to provide technologically advanced diagnostic and surgical resources.29”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites [29] source

      The citing authors’ statement that they did not assess differences between specialist types describes their own study, not the cited paper. The cited paper’s Methods describe a survey of primary care physicians, and its Discussion addresses limitations concerning patient race and insurance status; neither section addresses whether procedural or surgical specialists depend more on affiliated hospitals for advanced resources. Searched for the specialist distinction and hospital-resource dependence. (LLM, conf=0.72)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Findingown data

    Overall, 66% of Medicaid-CHIP callers (179 of 273) were denied an appointment, as compared with 11% of privately insured callers (29 of 273) (relative risk, 6.2; 95% CI, 4.3 to 8.8; P<0.001).

    “Overall, 66% of Medicaid-CHIP callers (179 of 273) were denied an appointment as compared with 11% of privately insured callers (29 of 273) (relative risk, 6.2; 95% confidence interval [CI], 4.3 to 8.8; P<0.001).”
    • Also stated in: § Outcomes · plain
      “As shown in Table 2, 66% (179) of the callers reporting Medicaid-CHIP coverage were denied an appointment for specialty care, as compared with 11% (29) of the callers reporting Blue Cross Blue Shield insurance (relative risk, 6.2; 95% confidence interval [CI], 4.3 to 8.8; P<0.001).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    Relative risks could not be calculated because there were no denials of care for children with private insurance.

    “Relative risks could not be calculated because there were no denials of care for children with private insurance.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    The percentage of clinics denying appointments for publicly insured children was 65.6% overall, compared with 10.6% for privately insured children.

    “65.6 10.6”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The odds of appointment denial with public insurance varied by specialty, with odds ratios ranging from 8.0 for psychiatry to 44.2 for orthopedics.

    “44.2 (7.9-∞) § | 42.8 (7.6-∞) § | 38.5 (6.8-∞) § | 34.1 (6.0-∞) § | 9.0 (2.2-79.9) | 9.0 (1.2-394.5) | 8.0 (1.9-71.7)”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Provider-related barriers to specialist care are potentially modifiable through health care policies, whereas patient-related or family-related barriers are less malleable to change.

    “In contrast to patient-related or family-related barriers, which are less malleable to change, providerrelated barriers are potentially modifiable through health care policies.16”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] source

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The order of reported insurance type, the only variable differing between the two calls, was randomly assigned.

    “The same caller called the same clinic twice.The order of reported insurance type, the only variable differing between the two calls, was randomly assigned.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Children covered by Medicaid-CHIP may have a greater need for specialty care because of the association between socioeconomic disadvantage and poor health status.

    “Given the association between socioeconomic disadvantage and poor health status, children covered by Medicaid-CHIP may have a greater need for specialty care.17”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] source

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    The calls to the same clinic were separated by 1 month and varied only by insurance status (private vs. Medicaid-CHIP insurance).

    “The calls were separated by 1 month and varied only by insurance status (private vs. Medicaid-CHIP insurance).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The study was approved, with a waiver of the requirement for informed consent, by institutional review boards at two institutions.

    “The study was approved, with a waiver of the requirement for informed consent, by institutional review boards at two institutions, with the caveat that debriefing letters be sent to all clinics in the entire sampling frame at the conclusion of the study.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    To control for the racial or ethnic characteristics of a caller's name and voice, all samples were randomly assigned to one of three groups of callers (black, white, or Hispanic).

    “To control for the racial or ethnic characteristics of a caller's name and voice, all samples were randomly assigned to one of three groups of callers (black, white, or Hispanic) with the use of a computer algorithm.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    In a 1994 study, the Medicaid Access Study Group found that adult patients with Medicaid had poor access to outpatient care.

    “Using this approach in a 1994 study, the Medicaid Access Study Group found that adult patients with Medicaid had poor access to outpatient care.20”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] source

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    To avoid geographic discrimination, all specialty clinics were geocoded and fake patient and PCP addresses were generated in the vicinity of each clinic.

    “To avoid geographic discrimination, we geocoded all specialty clinics and generated fake patient and PCP addresses that were in the vicinity of (but more than 1.6 km [1 mi] from) each clinic with the use of ArcGIS software (version 9.3).”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Additional variables beyond reimbursement affect physicians' decisions about whether to accept public insurance, such as delays in payment and hassles of payment procedures, personal characteristics of providers, and structural features of the system in which they provide care.

    “the literature indicates that additional variables affect physicians' decisions about whether to accept public insurance, such as delays in payment and hassles of payment procedures, 35,36 personal characteristics of providers (e.g., credentials or experience, 34,38,39 race or ethnic group, 34,[38][39][40][41] and underlying attitudes or prejudices 39,42 ), and structural features of the system in”
    Quote in the paperNot a substantial claim0 of 6 sources checked
    • cites [35] source
    • cites [36]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [34] source
    • cites [38]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [39]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites [42]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Standardized responses to questions were prepared through piloting and iterative review to indicate that the conditions were urgent (but not emergencies), common, and warranted specialty care.

    “Standardized responses to questions were prepared through piloting and iterative review to indicate that the conditions were urgent (but not emergencies), common, and warranted specialty care.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

    Interpretationnone given

    Access to specialty care may be different for uninsured children and for publicly insured or uninsured adults.

    “it should be noted that access to specialty care may be different for uninsured children and for publicly insured or uninsured adults.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    Each of the 273 clinics was called twice (for a total of 546 calls) by the same caller, with only insurance coverage varying between the two calls: once reporting Medicaid-CHIP coverage and once reporting private coverage.

    “Each of the 273 clinics was called twice (for a total of 546 calls) by the same caller, with only insurance coverage varying between the two calls: once reporting Medicaid-CHIP coverage and once reporting private coverage.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationown data

    Our results corroborate and add to Kogan et al.'s finding by measuring the real-life experience of attempting to schedule an appointment when all other factors besides insurance status are held constant.

    “Our results corroborate and add to this important finding by measuring the real-life experience of attempting to schedule an appointment when all other factors besides insurance status (e.g., parental persistence or savvy and the child's clinical symptoms) are held constant.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    The order of the reported insurance status was randomly assigned.

    “the order of the reported insurance status was randomly assigned.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    A pilot study of the scripts with standardized responses to possible questions was conducted between November 2009 and January 2010.

    “A pilot study of these scripts with standardized responses to possible questions was conducted between November 2009 and January 2010.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The study did not identify the causes of interspecialty variation.

    “In addition, we did not identify the causes of interspecialty variation.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S2 (checkable).

    Study design and conductreasoning

    The strength of the current study stems from its ability to isolate the effect of one dimension of access.

    “The strength of the current study stems from its ability to isolate the effect of one dimension of access.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    The study only assessed access to specialty care for publicly and privately insured children.

    “Our study only assessed access to specialty care for publicly and privately insured children”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductreasoning

    The final sample included all specialists for whom there was any evidence that they provided care to children (0 to 18 years of age) residing in Cook County.

    “The final sample included all specialists for whom there was any evidence that they provided care to children (0 to 18 years of age) residing in Cook County.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductnone given

    Clinical scenarios were chosen by pediatric primary care providers and specialist consultants with an iterative review process to identify conditions that affect a large number of children, warrant timely outpatient specialty evaluation and treatment, are urgent situations but not emergencies, and have a known effective treatment.

    “Clinical scenarios (involving a diagnosis and symptoms in a patient of a specified age) were chosen by pediatric primary care providers (PCPs) and specialist consultants with the use of an iterative review process to identify conditions that affect a large number of children, warrant timely outpatient specialty evaluation and treatment to achieve optimal health outcomes, are urgent situations but”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The significance of wait-time disparities by specialty type was not tested because of the small number of clinics that scheduled appointments for both insurance types.

    “We did not test the significance of wait-time disparities by specialty type because of the small number of clinics that scheduled appointments for both insurance types.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    The results showed significant disparities in children's access to needed outpatient specialty care, attributable to specialists' reluctance to accept public health insurance.

    “The results showed significant disparities in children's access to needed outpatient specialty care, attributable to specialists' reluctance to accept public health insurance.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data

    The study completed 546 paired calls to 273 specialty clinics.

    “We completed 546 paired calls to 273 specialty clinics and found significant disparities in provider acceptance of Medicaid-CHIP versus private insurance across all tested specialties.”
    • Also stated in: § Clinics · plain
      “Two completed calls were made to each of the remaining 273 clinics (546 total calls).”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    There is no evidence that pediatric specialists working in inpatient or rural settings are unwilling to accept Medicaid-CHIP.

    “In particular, there is no evidence that pediatric specialists working in inpatient or rural settings are unwilling to accept Medicaid-CHIP.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductreasoning

    The experimental design affords high internal validity within the context of understanding specialist behavior relative to simulated children's insurance status, with adequate controls for clinical urgency and other patient-level factors.

    “Nonetheless, our experimental design affords high internal validity within the context of understanding specialist behavior relative to our simulated children's insurance status, with adequate controls for clinical urgency and other patient-level factors.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    In Illinois, an office consultation visit for a problem of moderate severity (Healthcare Common Procedure Coding System code 99243) is reimbursed at $99.86 by Medicaid-CHIP, whereas the average reimbursement for the same code by a commercial preferred-provider organization is approximately $160.

    “In Illinois, an office consultation visit for a problem of moderate severity (Healthcare Common Procedure Coding System code 99243) is reimbursed at $99.86 by Medicaid-CHIP, 37 whereas the average reimbursement for the same code by a commercial preferred-provider organization is approximately $160.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [37]

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationreasoning

    Caution is needed in generalizing the results to specialists other than those in the specific specialties and region audited.

    “Caution is needed in generalizing our results to specialists other than those in the specific specialties and region that were audited in this study.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    Because of an extreme split on the dependent variable for orthopedics, asthma, otolaryngology, and dermatology, exact conditional (fixed-effects) logistic-regression odds ratios are medium unbiased estimates with no upper limit of the 95% confidence interval.

    “Because of an extreme split on the dependent variable for orthopedics, asthma, otolaryngology, and dermatology, exact conditional (fixed-effects) logistic-regression odds ratios are medium unbiased estimates with no upper limit of the 95% confidence interval.”
    Quote in the paperNot a substantial claim
34 of 34

  • The paper relies on this without support.

    Research on children's access to specialty care has not adequately distinguished between provider-related barriers and patient-related ones.

    “To date, research on children's access to specialty care has not adequately distinguished between provider-related barriers and patient-related ones.”
1 of 1

Cites

Flagged first, then by citations

Research works printed but not linked: 2

  1. Coburn AF, 1999, Inquiry, 36, 265
  2. Perloff JD, 1995, Health Serv Res, 30, 7

Cited by

Sorted by citations

Related

Authors
Bisgaier, J., & Rhodes, K. V.
Affiliations
University of Pennsylvania (US)
ORCID
Rhodes, Karin V.
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
2011-06-16
Volume
364
Issue
24
Pages
2324-2333
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejmsa1013285
OpenAlex
W2106036024
Semantic Scholar
e71464628d0825673d4822789f1dfaa330229535
Cited by
331
References
40
Citations by year
2026: 20 · 2025: 15 · 2024: 18 · 2023: 16 · 2022: 22 · 2021: 16 · 2020: 16 · 2019: 24 · 2018: 29 · 2017: 29 · 2016: 26 · 2015: 21 · 2014: 22 · 2013: 32 · 2012: 16
FWCI
62.04
Type
journal article
Language
en
Open access
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • University Libraries (University of Maryland) (submittedVersion)
  • Digital Repository at the University of Maryland (University of Maryland College Park)
Funders
University of Chicago
Topics
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
  • Health Sciences › Health Professions › General Health Professions › Child and Adolescent Health
  • Social Sciences › Economics, Econometrics and Finance › Finance › Healthcare Systems and Reforms
Keywords
access to specialist care, children, Medicaid, State Children's Health Insurance Program, public insurance, private insurance, insurance disparities, waiting time, outpatient care, health care reform
MeSH terms
Child, Child Health Services, Health Services Accessibility, Humans, Illinois, Insurance, Health, Medicaid, Specialization, United States, Insurance Coverage, Health Care Surveys, Clinical Audit, Patient Protection and Affordable Care Act

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