ER referral ups specialist access for publicly insured

Karin V. Rhodes, M.D., of the University of Pennsylvania in Philadelphia, and colleagues interviewed 26 specialists and 14 primary care physicians in Cook County, Ill., in an effort to better understand factors, including the role of emergency department referrals, influencing specialists' willingness to accept patients covered by Medicaid and the Children's Health Insurance Program (CHIP).

The researchers found that considerable barriers exist for primary care physicians to secure specialty care for publicly insured children and that the emergency department is used to facilitate this process. Many specialists reported being forced, due to economic concerns or institutional pressure, to limit the number of publicly insured pediatric patients they care for. Factors linked to specialist acceptance of patients with Medicaid/CHIP included high acuity or complexity, geography, patient hardship, and a personal request or an informal economic relationship with the primary care physician. For publicly insured patients, referral through the emergency department was a common and expected mechanism for access to specialty care.

"As our results show, inability to access specialty care can lead pediatric patients to the emergency department as well," the authors write. "Primary care providers and pediatric specialists alike acknowledged that using the emergency department as a 'middle-man' represents a viable 'work-around' in circumventing the access limitations faced by publicly insured children."

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Journal reference: Annals of Emergency Medicine

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