Medicaid Patients Have Decreased Access to Urologic Care: A Nationwide Cross-Sectional Study

This study quantifies (1) appointment accessibility and (2) need for referral for Medicaid and Medicare patients seeking urologic care nationwide.

We conducted a cross-sectional audit study of urology clinics across all 50 states. Using a standardized script, callers posed as Medicaid or Medicare patients requesting a new patient appointment. The primary end point was insurance acceptance (Medicaid vs Medicare), and the secondary end point was need for referral before appointment scheduling. We evaluated factors associated with these end points using multivariable analyses adjusting for clinic-level and state-level characteristics.

Of 1150 urology clinics contacted, 894 (77.7%) accepted Medicaid and 1141 (99.2%) accepted Medicare. On multivariable logistic regression, hospital-based clinics (odds ratio [OR] 2.41, 95% CI 1.33-4.36, P = .004), academic clinics (OR 3.63, 95% CI 1.96-6.72, P < .0001), rural clinics (OR 2.54, 95% CI 1.11-5.78, P = .027), and clinics with lower neighborhood income (OR 0.92 per $10,000, 95% CI 0.86-0.98, P = .009) were associated with increased Medicaid acceptance. The odds of a clinic requiring a referral were 13 times higher for Medicaid vs Medicare patients (OR 13.1, 95% CI 8.6-21.0, P < .001). Higher state Medicaid reimbursement rates were correlated with higher state Medicaid acceptance rates (P < .05).

Compared with Medicare patients, Medicaid patients nationwide face lower appointment availability and greater need for referrals when seeking urologic care. States with higher Medicaid reimbursement rates were associated with greater Medicaid accessibility.