Variation in Primary Care Wait Times in Medicaid: Explanatory Factors From an Experimental Design

Background: Timely access to primary care is important, particularly among patients with acute conditions and patients seeking a gateway to specialty care. Due to concerns that expanded Medicaid eligibility would compromise access to primary care among new Medicaid beneficiaries, an experimental study was conducted to test the ability to obtain timely appointments across 10 states in 2012, 2014, and 2016. While access to primary care appointments for simulated Medicaid patients significantly increased, wait times also increased. The current study explores the determinants of wait times and investigates whether they pose a greater barrier to Medicaid beneficiaries. Methods: Using data from the experimental study, we conducted linear regressions to determine the association between the number of days to scheduled appointments and the simulated patient’s clinical scenario (routine check-up vs. undiagnosed hypertension), practice-level characteristics, and county-level measures of primary care supply. We also stratified analyses based on the county-level concentration of Medicaid beneficiaries. Results: Simulated Medicaid patients faced 1.3 day longer wait times than commercially-insured ones. Participation in accountable care organizations and integrated health systems was associated with longer wait times, but did not appear to reduce wait time disparities across insurance types. Notably, the presence of federally qualified health centers in a given county was associated with lower wait times for simulated Medicaid patients. Conclusions: These findings highlight the complexity of access disparities for Medicaid patients and provide insight for future waves of health care reform.

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