Medicaid Patients with Lupus Travel Farther To See Specialists

Arthritis Care Research News Alerts. 2007;57(4):601-607. 

Medicaid is one of the nation's largest insurance programs, covering approximately 55 million people. Yet some studies suggest there is declining physician participation in the program, which limits access to enrolled patients, particularly to specialists. Systemic lupus erythematosus (SLE) is a chronic autoimmune condition whose sufferers face lifelong periods of disease flares and inflammation of numerous organ systems. Few studies to date have examined the effect of insurance status on access to care for rheumatology patients, and no studies have examined this question with regard to SLE patients. A new study published in the May 2007 issue of Arthritis Care & Research ( looked at distance to primary lupus providers in a large group of patients with SLE and found that those covered by Medicaid traveled further to see an SLE physician.

"The effects of Medicaid status on access may be particularly pronounced for those with chronic illnesses who depend on the care of a specialist," note the authors. Between 2002 and 2004, led by Joann Zell Gillis, MD, of the University of California, San Francisco, CA, researchers conducted telephone interviews with 982 SLE patients to determine demographics and socioeconomic status, status of SLE, disability, general health status and social functioning, employment, psychological and cognitive status, health care utilization, medications, and health insurance coverage. They also calculated the distance between patients' residences and primary SLE physicians.

The results showed that patients with Medicaid traveled longer distances to obtain SLE care by any health professional, especially rheumatologists. In addition, even though Medicaid patients were as likely to have seen a rheumatologist for a similar number of visits per year as those with other insurance, they reported more visits to general practitioners and to emergency rooms. "These results suggest that Medicaid patients may face barriers on obtaining comprehensive medical services in proximity to their residences," the authors state.

They acknowledge that the number of Medicaid patients in the study (58) may have been lower than what would normally be found in the general population of patients with SLE and that these patients were more likely to have come from university settings and therefore more likely to have been seen by a specialist. But this may reflect the fact that university centers are more willing to accept patients with Medicaid, and that patients face barriers in accessing care closer to home.

Future studies may investigate the potential downstream effects of limited access on healthcare quality and clinical outcomes, the authors note. They conclude, "The results of such a study would enable further exploration of the relationship between socioeconomic status and clinical outcomes, and perhaps influence the development of public policy promoting access to care for less advantaged populations."

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