The DOI matches its Crossref record; 41 of the 41 references it cites were found in a registry or an index; 4 of the 32 sources its claims cite were checked for support.
Auditing Access to Specialty Care for Children with Public Insurance
Open accessAbstract
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.
Overview
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
Cites
Statistics
Verification
Claims the paper makes
4 of 32 cited sources checked · 0 supported · 0 flagged · accuracy not yet measured
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“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”
§ Auditing Access to Specialty Care for Children with Public Insurance > E
What the sources say
- Partly supportedcites [14] sourceExperimental — accuracy not yet measured
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)
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“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”
§ Auditing Access to Specialty Care for Children with Public Insurance > E
What the sources say
- Not checked — no full text of the sourcecites [7] source
- Not checked — no full text of the sourcecites [13] source
- Partly supportedcites [21] sourceExperimental — accuracy not yet measured
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)
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Auditing Access to Specialty Care for Children with Public Insurance > Abstract
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Also stated in: § Outcomes · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“6.2 (4.3-8.8)”
§ Auditing Access to Specialty Care for Children with Public Insurance > Discussion
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Auditing Access to Specialty Care for Children with Public Insurance > Abstract
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Also stated in: § Outcomes · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Notably, even callers claiming to have a privately insured child faced an average wait time of 20 days when urgently requesting an appointment.”
§ Auditing Access to Specialty Care for Children with Public Insurance > Discussion
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“31.0 (13.0-96.8)”
§ Auditing Access to Specialty Care for Children with Public Insurance > Discussion
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesNone of the sources cited for this claim have been checked yet.
In the paper
“However, evidence suggests that the 37 million children covered by Medicaid-CHIP 4,5 are less likely to receive specialty care than children covered by commercial insurance.[6][7][8][9][10][11][12][13]”
§ Auditing Access to Specialty Care for Children with Public Insurance > E
What the sources say
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesA claim is checked only against the cited paper’s full text, never its abstract, and none is available for its sources.
In the paper
“However, most studies to date have been unable to directly control for children's clinical need for specialty services.6,18”
§ Auditing Access to Specialty Care for Children with Public Insurance > E
What the sources say
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIn the paper
“Audit methodology, traditionally used for detecting “real life” discriminatory behavior in housing and labor markets, can be used to assess insurance-related disparities in health care access.19”
§ Auditing Access to Specialty Care for Children with Public Insurance > E
What the sources say
- Not checked — no full text of the sourcecites [19] source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes
- Probably not a substantial claim. 24
- It may state two separate claims as one. 15
The cited sources that could be checked couldn’t confirm or dispute this claim.
In the paper
“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.”
§ Auditing Access to Specialty Care for Children with Public Insurance > Statistical Analysis
What the sources say
- Could not verifycites [21] sourceExperimental — accuracy not yet measured
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)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Could not verify
The cited sources that could be checked couldn’t confirm or dispute this claim.
In the paper
“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”
§ Auditing Access to Specialty Care for Children with Public Insurance > Discussion
What the sources say
- Could not verifycites [29] sourceExperimental — accuracy not yet measured
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)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Could not verify
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Auditing Access to Specialty Care for Children with Public Insurance > Abstract
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Also stated in: § Outcomes · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Relative risks could not be calculated because there were no denials of care for children with private insurance.”
§ Auditing Access to Specialty Care for Children with Public Insurance > Discussion
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“65.6 10.6”
§ Auditing Access to Specialty Care for Children with Public Insurance > Discussion
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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)”
§ Auditing Access to Specialty Care for Children with Public Insurance > Discussion
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“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”
§ Auditing Access to Specialty Care for Children with Public Insurance > E
What the sources say
- Not checked — no full text of the sourcecites [16] source
Tests✓ Asserted: passes? Checkable: unclear✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Auditing Access to Specialty Care for Children with Public Insurance > Specialty Conditions and Protocol
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
In the paper
“Given the association between socioeconomic disadvantage and poor health status, children covered by Medicaid-CHIP may have a greater need for specialty care.17”
§ Auditing Access to Specialty Care for Children with Public Insurance > E
What the sources say
- Not checked — no full text of the sourcecites [17] source
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The calls were separated by 1 month and varied only by insurance status (private vs. Medicaid-CHIP insurance).”
§ Auditing Access to Specialty Care for Children with Public Insurance > Data Collection and Study Design
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Auditing Access to Specialty Care for Children with Public Insurance > Study Oversight
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Auditing Access to Specialty Care for Children with Public Insurance > Specialty Conditions and Protocol
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
In the paper
“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”
§ Auditing Access to Specialty Care for Children with Public Insurance > E
What the sources say
- Not checked — no full text of the sourcecites [20] source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Auditing Access to Specialty Care for Children with Public Insurance > Specialty Conditions and Protocol
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
None of the sources cited for this claim have been checked yet.
In the paper
“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”
§ Auditing Access to Specialty Care for Children with Public Insurance > Discussion
What the sources say
- Not checked — no full text of the sourcecites [35] source
- Not matchedcites [36]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not checked — no full text of the sourcecites [34] source
- Not matchedcites [38]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not matchedcites [39]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Not matchedcites [42]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:hedged· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Auditing Access to Specialty Care for Children with Public Insurance > Discussion
Load-bearingStrength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“it should be noted that access to specialty care may be different for uninsured children and for publicly insured or uninsured adults.”
§ Auditing Access to Specialty Care for Children with Public Insurance > Discussion
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Auditing Access to Specialty Care for Children with Public Insurance > Discussion
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Auditing Access to Specialty Care for Children with Public Insurance > Discussion
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“the order of the reported insurance status was randomly assigned.”
§ Auditing Access to Specialty Care for Children with Public Insurance > Discussion
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“A pilot study of these scripts with standardized responses to possible questions was conducted between November 2009 and January 2010.”
§ Auditing Access to Specialty Care for Children with Public Insurance > Specialty Conditions and Protocol
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“In addition, we did not identify the causes of interspecialty variation.”
§ Auditing Access to Specialty Care for Children with Public Insurance > Discussion
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The strength of the current study stems from its ability to isolate the effect of one dimension of access.”
§ Auditing Access to Specialty Care for Children with Public Insurance > Discussion
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✗ Checkable: fails✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may be too vague to check against evidence.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Our study only assessed access to specialty care for publicly and privately insured children”
§ Auditing Access to Specialty Care for Children with Public Insurance > Discussion
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Auditing Access to Specialty Care for Children with Public Insurance > Sampling Methods
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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”
§ Auditing Access to Specialty Care for Children with Public Insurance > Specialty Conditions and Protocol
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Auditing Access to Specialty Care for Children with Public Insurance > Statistical Analysis
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The results showed significant disparities in children's access to needed outpatient specialty care, attributable to specialists' reluctance to accept public health insurance.”
§ Auditing Access to Specialty Care for Children with Public Insurance > Discussion
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Auditing Access to Specialty Care for Children with Public Insurance > Abstract
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
- Also stated in: § Clinics · plain
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In particular, there is no evidence that pediatric specialists working in inpatient or rural settings are unwilling to accept Medicaid-CHIP.”
§ Auditing Access to Specialty Care for Children with Public Insurance > Discussion
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Auditing Access to Specialty Care for Children with Public Insurance > Discussion
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“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.”
§ Auditing Access to Specialty Care for Children with Public Insurance > Discussion
What the sources say
- Not matchedcites [37]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Not matched
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Caution is needed in generalizing our results to specialists other than those in the specific specialties and region that were audited in this study.”
§ Auditing Access to Specialty Care for Children with Public Insurance > Discussion
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Auditing Access to Specialty Care for Children with Public Insurance > Discussion
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
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.”
Citations
Cites
Coordinating Care — A Perilous Journey through the Health Care System
Bodenheimer, T. S. (2008) · New England Journal of Medicine · doi:10.1056/nejmhpr0706165 · Cited by 994
The Role of Black and Hispanic Physicians in Providing Health Care for Underserved Populations
Komaromy, M., Grumbach, K., Drake, M., Vranizan, K., Lurie, N., Keane, D., & Bindman, A. B. (1996) · New England Journal of Medicine · doi:10.1056/nejm199605163342006 · Cited by 915
Access to Health Care in America
Institute of Medicine (1993) · National Academies Press eBooks · doi:10.17226/2009 · Cited by 649
Clear and convincing evidence: measurement of discrimination in America
(1994) · Choice Reviews Online · doi:10.5860/choice.31-5163 · Cited by 359
Insurance Status and Access to Urgent Ambulatory Care Follow-up Appointments
Asplin, B. R. (2005) · JAMA · doi:10.1001/jama.294.10.1248 · Cited by 271
Spriggs, W. E., Fix, M. E., & Struyk, R. J. (1994) · Industrial and Labor Relations Review · doi:10.2307/2524673 · Cited by 228
Access of Medicaid Recipients to Outpatient Care
(1994) · New England Journal of Medicine · doi:10.1056/nejm199405193302007 · Cited by 180
Skaggs, D. L., Lehmann, C. L., Rice, C., Killelea, B. K., Bauer, R. M., Kay, R. M., & Vitale, M. G. (2006) · Journal of Pediatric Orthopaedics · doi:10.1097/01.bpo.0000217715.87857.24 · Cited by 155
Access to Orthopedic Care for Children With Medicaid Versus Private Insurance in California
Skaggs, D. L., Clemens, S. M., Vitale, M. G., et al. (2001) · PEDIATRICS · doi:10.1542/peds.107.6.1405 · Cited by 154
Berman, S., Dolins, J. C., Tang, S. S., & Yudkowsky, B. K. (2002) · PEDIATRICS · doi:10.1542/peds.110.2.239 · Cited by 144
Flagged first, then by citations
Research works printed but not linked: 2
- Coburn AF, 1999, Inquiry, 36, 265
- Perloff JD, 1995, Health Serv Res, 30, 7
Cited by
Sorted by citations
Items 301–331 of 331
Factors that influence health-related quality of life in adolescents with sickle cell disease
Brewer, C. A. (2019) · Carolina Digital Repository (University of North Carolina at Chapel Hill) · doi:10.17615/hbhz-t580
Access to Care: Access Is a Prerequisite to Quality
Rhodes, K., & Samuels-Kalow, M. E. (2021) · Social Emergency Medicine · doi:10.1007/978-3-030-65672-0_8
Self-citationThe Economics of Sexual and Mental Health
Harrell, B. J. (2022) · Digital Archive @ GSU · doi:10.57709/24098148
Halla, M., Kah, C., & Sausgruber, R. (2022) · SSRN Electronic Journal · doi:10.2139/ssrn.4052259
“10There is also evidence on the importance of insurance status from experimental audit and correspondence studies in the US (see, for instance, Bisgaier and Rhodes, 2011; Polsky et al., 2015).”
BackgroundSerban, N. (2019) · doi:10.1002/9781119601340.ch6
Health disparities in facial plastic surgery
Arosarena, O. A., & Jegede, V. O. (2023) · Elsevier eBooks · doi:10.1016/b978-0-443-10714-6.00011-0
Reich, D. A., Giraldo, G., Canty, W., et al. (2024) · Pediatric Surgery International · doi:10.1007/s00383-024-05645-9
Medicaid and pediatric subspecialty care
Saper, J. K., Raphael, J. L., Chamberlain, L. J., et al. (2024) · Pediatric Research · doi:10.1038/s41390-024-03275-4
Barriers to auditory brainstem response testing under anesthesia
Tunkel, A., Benbourenane, A. N., Behzadpour, H. K., et al. (2024) · International Journal of Pediatric Otorhinolaryngology · doi:10.1016/j.ijporl.2024.112124
Examining Impact of Insurance Type on Genetic Testing in Pediatric Neurology
Carnes, S., Fonseca, L. D., Lee, D., Parekh, A., Robertson, A. M., & Kumar, G. (2024) · Pediatric Neurology · doi:10.1016/j.pediatrneurol.2024.09.029
Racial and Ethnic Disease Phenotype Differences Are Driven by Genetics: No
Langer-Gould, A. M. (2024) · Multiple Sclerosis Journal · doi:10.1177/13524585241292957
“13 Even with the same insurance, one small study found that Black and Hispanic MS patients were less likely to be started on or escalated to highly efficacious therapies than White patients.”
(2000) · Time to knit · doi:10.1016/j.yped.2015.07.120
Halla, M., Kah, C., & Sausgruber, R. (2021) · SSRN Electronic Journal · doi:10.2139/ssrn.5243396
Coster, M. E., Vanderfaeillie, J., West, D., Verheyden, C., Pīgozne, T., Pivorienė, J., & Holen, F. V. (2025) · Child & Family Social Work · doi:10.1111/cfs.70035
Afarideh, M., Anderson, K., & Tollefson, M. M. (2025) · Pediatric Dermatology · doi:10.1111/pde.16040
“Notably, dermatology ranks among the top three specialties with limited access to Medicaid or CHIP patients [17], although this may be a less significant concern in many academic settings.”
Additional file 1 of Effects of variations in access to care for children with atopic dermatitis
Siegfried, E. C., Paller, A. S., Mina‐Osorio, P., Vekeman, F., Kaur, M., Mallya, U. G., Héroux, J., Miao, R., & Gadkari, A. S. (2020) · Figshare · doi:10.6084/m9.figshare.13467561
High Health Care Utilization Preceding Diagnosis With Juvenile Idiopathic Arthritis
Costello, A., Xiao, R., Zhang, X., et al. (2026) · Arthritis Care & Research · doi:10.1002/acr.80037
“38 With MarketScan data, we are unable to determine the etiology of these differential utilization patterns between insurance types and whether other demographic factors, such as socioeconomic status, geographic region, or race and ethnicity, are the drivers of the differences.”
Horovitz, O., Corcoran, E. C., Said, M., et al. (2026) · Journal of Pediatric Orthopaedics · doi:10.1097/bpo.0000000000003266
Language barriers in pediatric food allergy care: A single-center study on healthcare disparities
Wong, K. H., Pandya, N., McCollum, S., et al. (2026) · PLoS ONE · doi:10.1371/journal.pone.0346248
“Medicaid-enrolled children were more likely to have delays in establishing allergy care, have underdiagnosis of FA, and low epinephrine autoinjector prescription fill rates [19,20].”
Coster, M. E., Vanderfaeillie, J., West, D., Verheyden, C., Pīgozne, T., & Holen, F. V. (2026) · Children and Youth Services Review · doi:10.1016/j.childyouth.2026.108967
Telemedicine and Access to Pediatric Dermatology Care
Everdell, E. M., Barry, K. K., & Hawryluk, E. B. (2026) · Pediatric Clinics of North America · doi:10.1016/j.pcl.2026.03.008
Missed outpatient appointments: Who's missing out and Why?
Harwood, E. A., Lassman, D., James, E., et al. (2026) · Journal of Pediatric Urology · doi:10.1016/j.jpurol.2026.106060
Angulo-Lozano, J. C., Venkatapuram, P., Balili, R., Sharma, A., Brown‐Johnson, C. G., & Kan, K. M. (2026) · Research Square · doi:10.21203/rs.3.rs-9773556/v1
Bergus, K. C., Srivatsa, S., Kalady, S. E., et al. (2026) · Journal of Pediatric Surgery · doi:10.1016/j.jpedsurg.2026.163299
Boyd, L., Nightingale, C., Martínez-Gutiérrez, J., et al. (2026) · Cancer Causes & Control · doi:10.1007/s10552-026-02215-3
Socioeconomic determinants of recurrent DKA in US children
Al-Saidi, N., Fatima, Z., Esseili, A. S., Ziehl, E., Siddiqui, H., Kizy, S., & Rain, U. Z. (2026) · Journal of Pediatric Endocrinology and Metabolism · doi:10.1515/jpem-2026-0352
“A study by Bisgaier et al. [36] found that children with public health insurance experienced reduced access to outpatient care, particularly subspecialty services, and waited an average of 22 days longer for appointments than children with private insurance.”
Inpatient Deaths in Pediatric Leukodystrophies
Hart, H. S., Vordos, K. L., Flood, C. T., et al. (2026) · Annals of the Child Neurology Society · doi:10.1002/cns3.70086
Grier, K., Duncan, D. F., Chung, R., Terrell, L., Harlow, A. B., Jones‐Hepler, B., Brandon, D., & Gonzalez-Guarda, R. M. (2026) · Journal of Child and Family Studies · doi:10.1007/s10826-026-03343-9
“Although foster youth are typically Medicaid insured, coverage limitations and low reimbursement rates may reduce provider participation, resulting in fewer available services (Bisgaier & Rhodes, 2011; Szilagyi et al., 2015).”
Gomes, N., Martínez-Donate, A. P., & Pintor, J. K. (2026) · Academic Pediatrics · doi:10.1016/j.acap.2026.103459
Prenatal Diagnosis of Orofacial Clefts: Impact on Care Timelines and Patient-Reported Outcomes
Le, T., Gomez, D. A., Feng, E., Colsman, I., Li, C., French, B., Khechoyan, D. Y., & Nguyen, P. D. (2026) · FACE · doi:10.1177/27325016261485451
Metadata
- 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
- 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
- bronze
- doi.org
- 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 › Medicine › Pediatrics, Perinatology and Child Health › Child and Adolescent Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-10-14, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-14 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Cited sources are checked with a language model’s help (gpt-6-sol).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
