What Factors Determine Access to Care?

New research sheds light on one potential driver of disparities in care based on patient race, ethnicity, and insurance coverage.

When compared with their junior colleagues in the same practice, the senior physicians are less likely to treat patients covered by Medicaid, a program for low-income individuals who are disproportionately Black and Hispanic. This divergence raises concerns regarding a 2-tier system prohibiting access to experienced care for underprivileged patients and expanding existing racial and economic disparities in healthcare.

The research published in JAMA Network Open was authored by Hannah Neprash, PhD, David Chan, MD, PhD, Professor Ateev Mehrotra, MD, MPH, and Associate Professor Michael Barnett, MD sheds light on this issue.

Using two most recent datasets of patients from athenahealth and Medicare, the study compared Medicaid enrollment and minority group representation of patients seen by doctors within the same practice, categorized by seniority.

They found that senior physicians treated fewer Medicaid patients and patients from minority groups compared to their junior colleagues. The gap was most pronounced for procedural specialties but absent for nonoffice based specialties.

These results raise concerns regarding healthcare inequality for underprivileged patients, and question whether seniority should dictate access to experienced care. Further investigation is needed to determine what factors are driving the gap; whether this is based on doctor preference, patient choice, lower reimbursement rates for Medicaid, or other factors.