0824 GMT May 20, 2019
All those waits for appointments and physician shortages that have long plagued the state’s low-income health insurance program — a program that one out of every three Californians now relies on — could be remedied with a simple dose of economics, dailynews.com reported.
But in healthcare, nothing is that simple.
Yes, while debate over the future of Obamacare waxes and wanes in Congress, California doctors are happily preparing for their first state pay increase in Medi-Cal in 17 years. Physicians and advocates for low-income patients pried a $325 million raise from a reluctant Gov. Jerry Brown, who was skeptical that a doctor pay increase would translate to better care.
Even so, civil rights groups and some California labor unions are suing the state to pay doctors significantly more — the latest in a long history of legal actions that blame meager Medi-Cal reimbursement rates for delays in patient care.
One way or another, California doctors are likely to get a pay raise soon. Here’s what you need to know about how physicians may respond — and how it could impact the ability of 13 million Californians to see the doctors they need, when they need them.
How tough is it for Medi-Cal patients to get the care they need?
Overall, Medi-Cal patients have a tougher time getting the care they need than similar patients in other states, where the same program goes by its federal name, Medicaid. Recipients outside California are more likely to have visited a specialist and received a flu vaccination than recipients in California.
Medi-Cal recipients also were about five percent more likely to report delaying care because of difficulty getting an appointment.
Users of private insurance and Medicare (the federal health program for older people) typically fare better than Medi-Cal patients. Medi-Cal enrollees were more than twice as likely as adults with employer-sponsored insurance to use the emergency room as a usual source of care — a costly problem for the state.
Access problems are most severe for certain in-demand specialties such as psychiatry, which are even harder to come by for rural patients.
California has legally binding standards for access to care, including a maximum of a 15-day wait for specialist appointments and no more than a 90-minute drive to care for rural patients.
Unfortunately, the state has trouble collecting the data it needs to see if health plans it contracts with are actually complying with those standards.