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baltimoresun.com

Health insurance and doctor availability [Letter]

12:00 PM EDT, April 16, 2014

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The statistics reported in the article, "Doctor appointment availability varies by insurance type" (April 7), were alarming and deserve reflection and pause by your readers and all Baltimoreans. The findings highlight a challenging issue for our health care system as more people enroll in insurance plans, both private and Medicaid, thanks to the Affordable Care Act. But this isn't a new issue and goes to the core of our societal notions of fairness.

The fact that there was such a wide gap between the ability of someone with private insurance to get an appointment with a new primary care doctor versus those with Medicaid (85 percent versus 58 percent) raises a red flag — both in terms of the numbers themselves and the potential assumption that high-quality doctors are often not giving appointments to Medicaid patients. At the same time, the idea that 85 percent is considered success at all is concerning. What good is commercial insurance if you can only find a doctor 85 percent of the time?

Unfortunately, in traditional fee-for-service medicine, doctors are often forced into the businessman's dilemma of trying to optimize the payment for their time by limiting appointments given to patients with lower paying insurance (Medicaid programs) and increasing the proportion of their time spent seeing patients with higher paying insurance plans.

We all deserve an approach that removes this type of misaligned incentive from care delivery and allows physicians to remain focused on patients and practicing medicine, not the burden of reimbursement.

We encourage everyone in the process of choosing a health plan, whether private insurance or a government-sponsored plan, to research whether or not physicians have "open panels," meaning they are accepting new patients. A truly open panel accepts all new patients irrespective of whether their insurance plan is provided by their employer, the government, or self-paid. What's more, getting an appointment is just half the battle. The other half is getting care when you need it. Ask if those open panel physicians provide same-day appointments and how long it takes to see a specialist. Ask if they are embracing the way people live today: Do they let you book an appointment by phone or online, do they email or offer video appointments? We believe it is about time the entire medical community begins to reduce barriers for people to receive high-quality care.

There may be many ways to address the challenges the article calls out. At Kaiser Permanente, we take great pride in our more than 1,000 high quality Mid-Atlantic physicians who focus on care. Every person deserves equal access to high quality care. It's simply the right thing to do.

Kim Horn and Dr. Bernadette Loftus, Rockville

The writers are, respectively, president of Kaiser Permanente Mid-Atlantic States and associate executive director of The Permanente Medical Group.

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