The following is a summary of “Medicaid coverage and access to obstetrics and gynecology subspecialists: findings from a national mystery caller study in the United States,” published in the JUNE 2023 issue of Obstetrics and Gynecology by Corbisiero, et al.

Previous research has shown that access to healthcare can impact the diagnosis and treatment of obstetrical and gynecologic conditions. Audit studies, which employ a single-blinded and patient-centered design, have measured access to healthcare services. However, no study has specifically assessed the dimensions of access to obstetrics and gynecologic subspecialty care based on insurance type, particularly Medicaid versus commercial insurance. For a study, researchers sought to evaluate the average wait time for a new patient visit to subspecialists in female pelvic medicine and reconstructive surgery, gynecologic oncology, maternal-fetal medicine, and reproductive endocrinology and infertility for patients with Medicaid versus commercial insurance.

A random sample of 800 unique physicians from each subspecialty across the United States was selected from patient-facing physician directories. Each physician was contacted twice, with one call presenting Medicaid insurance and another presenting Blue Cross Blue Shield insurance. The order of the calls was randomized. The caller requested the soonest available appointment for specific medical conditions related to each subspecialty, including stress urinary incontinence, new-onset pelvic mass, pre-conceptual counseling after an autologous kidney transplant, and primary infertility.

Out of the initial 800 physicians contacted, 477 responded to at least one call in 49 states and the District of Columbia. The average wait time for a new patient appointment was 20.3 business days, with a standard deviation of ±18.6 days. A significant difference was found in new patient appointment wait times based on insurance type, with Medicaid patients experiencing a 44% longer wait time than those with commercial insurance (ratio, 1.44; 95% CI, 1.34-1.54; P<.001). When the interaction between insurance type and subspecialty was included in the analysis, it remained highly significant (P<.01). Specifically, Medicaid-insured patients seeking care in female pelvic medicine and reconstructive surgery had the longest wait times compared to commercially insured patients. Patients seeking care in maternal-fetal medicine had the smallest difference, but Medicaid-insured patients still experienced longer wait times than those with commercial insurance.

On average, patients can expect to wait 20.3 days for a new patient appointment with a board-certified obstetrics and gynecology subspecialist. However, callers presenting with Medicaid insurance experienced significantly longer wait times for new patient appointments compared to callers with commercial insurance.

Source: ajog.org/article/S0002-9378(23)00147-3/fulltext