New report finds no evidence that safety-net patients receive substandard primary care

(Press-News.org) WASHINGTON and NEW YORK—A new study by researchers at the George Washington University School of Public Health and Health Services (SPHHS) finds no evidence that primary care physicians provide "second-class" care to Medicaid, uninsured and other patients who rely on the nation's safety-net system. The study, which appears in the September issue of the journal Health Affairs, challenges previous claims that the care provided to low-income and vulnerable patients is substandard. The new study was supported by the Geiger/Gibson RCHN Community Health Foundation Research Collaborative.

"The findings refute the belief that primary care doctors deliver less care to the nation's poor," says lead author Brian K. Bruen, MS, lead research scientist in the Department of Health Policy at the SPHHS. "We examined data from more than 31,000 primary care visits from 2006 to 2010 and found nothing to indicate that primary care doctors skimped on the time they spent with uninsured or other safety-net patients, or the amount of care provided during those visits, when compared to visits by patients with private insurance."

Critics have long argued that stressors on Medicaid and the safety-net system have led to substandard or second-class care. To examine this assumption, SPHHS researchers analyzed data from the National Ambulatory Medical Care Survey, which includes nationally representative samples of physician office visits. The researchers looked at the time that patients spent with doctors, the volume of diagnostic and treatment services provided and whether preventive health counseling was offered during visits.

On average, primary care physicians spent 18 minutes with each patient. Primary care doctors spent more time with new patients compared to established patients. They also spent more time with patients who had more serious medical problems. The authors found no meaningful differences by type of patient insurance in either duration of the physician visit or the type and scope of services rendered.

"We examined whether the pressures of trying to provide care to the uninsured or to patients with Medicaid might lead physicians to take short cuts," says co-author Leighton Ku, PhD, MPH, the Director of the Center for Health Policy Research at SPHHS. "This study indicates that most primary care physicians make medical decisions based on their patients' health needs, not their insurance status."

The study also found no evidence that the length of the typical primary care visit varied by practice type or site. Patients receiving care from community health centers spent as much time with the physician as those in private doctors' offices or other settings.

Taken together, the findings suggest the nation's safety-net system remains a crucial part of the health care landscape, providing care comparable to that offered in other settings. At the same time, the authors note that the findings are not intended to suggest that there is no room for improvement. Ensuring both access and quality of care for all patients remains an essential priority for the future, the authors say.

"This study shows that primary care doctors working in community health centers and other settings provide all patients with comparable care, irrespective of insurance status, says Feygele Jacobs, president and CEO of the RCHN Community Health Foundation. "Community health centers currently provide care to more than 22 million people and will need continued support in order to expand access and enhance quality under health reform."

The study, "No Evidence That Primary Care Physicians Offer Less Care to Medicaid, Community Health or Uninsured Patients," appears in the September issue of the journal Health Affairs.

### About the Geiger Gibson / RCHN Community Health Foundation Research Collaborative: The Geiger Gibson Program in Community Health Policy, established in 2003 and named after human rights and health center pioneers Drs. H. Jack Geiger and Count Gibson, is part of the School of Public Health and Health Services at The George Washington University. It focuses on the history and contributions of health centers and the major policy issues that affect health centers, their communities, and the patients that they serve. Additional information about the Research Collaborative can be found online at http://www.gwumc.edu/sphhs/departments/healthpolicy/ggprogram or at rchnfoundation.org.

About the RCHN Community Health Foundation: The RCHN Community Health Foundation is a not-for-profit operating foundation established to support community health centers through strategic investment, outreach, education, and cutting-edge health policy research. The only foundation in the U.S. dedicated solely to community health centers, RCHN CHF builds on a long-standing commitment to providing accessible, high-quality, community-based healthcare services for underserved and medically vulnerable populations. The Foundation's gift to the Geiger Gibson program supports health center research and scholarship. For more information, visit http://www.rchnfoundation.org.

About the George Washington University School of Public Health and Health Services: Established in July 1997, the School of Public Health and Health Services brought together three longstanding university programs in the schools of medicine, business, and education and is now the only school of public health in the nation's capital. Today, more than 1,100 students from nearly every U.S. state and more than 40 nations pursue undergraduate, graduate, and doctoral-level degrees in public health. The school now offers an online Master of Public Health, MPH@GW, which allows students to pursue their degree from anywhere in the world. http://sphhs.gwu.edu/