Disparities in Primary Care Wait Times in Medicaid versus Commercial Insurance

Background: Timely access to primary care is important, particularly among patients with acute conditions and patients seeking gateways 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. Although access to primary care appointments for simulated Medicaid patients significantly increased, wait times also increased. This study explores the determinants of wait times and whether they pose greater barriers to Medicaid beneficiaries. Methods: We conducted linear regressions to determine the association between the number of days to scheduled appointments and the simulated patient's clinical scenario, practice-level characteristics, and county-level measures of primary care supply. Results: Simulated Medicaid patients faced 1.3 days 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 seem 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.