A 2010 Government Accountability Office survey of physicians who serve children found that physicians have a harder time referring their pediatric patients in Medicaid and the Children's Health Insurance Program (CHIP) to specialty care than they do when they refer children covered by private insurance.
The GAO's physician survey sought to find out how many physicians are enrolled in Medicaid and CHIP and serving children in those programs; how many of them are accepting new patients in those programs and outside the programs; and how much difficulty doctors experience referring children in those programs for specialty care in comparison to their experience of referring children with private insurance.
The GAO surveyed a nationally representative sample of specialty care physicians and primary care physicians in urban and rural areas providing care to children up to the age of 18. The GAO had a response rate of 35 percent, receiving responses from 932 eligible physicians.
According to the survey, an estimated 78 percent of physicians are enrolled in Medicare and CHIP. More primary care physicians than specialty physicians participate in Medicaid and CHIP – 83 percent and 71 percent, respectively, and participation is higher in rural areas than in urban. Of those participating in the federal programs, 79 percent are accepting new, privately insured patients and 47 percent are accepting new Medicaid or CHIP patients. Those not participating in the federal programs say they don't participate due to administrative issues such as low and delayed reimbursement and provider enrollment requirements.
Eighty-four percent of physicians participating in Medicaid and CHIP said they experience greater difficulty referring children in the federal programs to specialty care than they do when referring children covered by private insurance. Only 26 percent said they experience difficulty referring their privately insured patients to specialty care. For all children, physicians most frequently cited difficulty with specialty referrals for mental health, dermatology, and neurology.