提供方目录不准确和及时获得物理治疗

IF 1.7 Q3 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH World Medical & Health Policy Pub Date : 2024-04-02 DOI:10.1002/wmh3.607
Thomas Elton, Wendy Y. Xu, Simon F. Haeder
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引用次数: 0

摘要

患者能否在其网络中找到理疗师,以及能否在需要时获得理疗?为了回答这些问题,我们利用从加利福尼亚州管理式医疗保健部获得的二手数据,分析了 2018 年和 2019 年加利福尼亚州所有管理式医疗保健计划的医疗服务提供者目录准确性和理疗师的及时就诊情况,共计 119,084 份理疗列表(2018 年为 60,967 份,2019 年为 58,117 份)。总体而言,2018 年有 19% 的列表医疗服务提供者和 2019 年有 8% 的列表医疗服务提供者显示不准确。然而,我们发现不同市场之间存在巨大差异,2018 年医疗补助列表的准确率最低,仅为 54%。商业计划的准确性一直最高。在充足性方面,我们发现 90% 以上的列名医疗服务提供者可在 15 天内访问,97% 可在 30 天内访问,其中医疗补助计划提供的及时访问率最高。总体而言,消费者获得理疗服务的障碍似乎主要体现在医疗服务提供者名录的不准确性上。高不准确率引起了患者和监管机构的担忧。归根结底,加利福尼亚州是在网络充足性和就医方面监管最严格的州之一。
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Provider directory inaccuracy and timely access to physical therapy
Can patients find physical therapists in their networks, and can they access physical therapy when they need to? To answer these questions, we analyzed provider directory accuracy and timely access for physical therapists for all managed care plans available in California in 2018 and 2019 using secondary data obtained from the California Department of Managed Health Care for a total of 119,084 physical therapy listings (60,967 for 2018 and 58,117 for 2019). Overall, 19% of listed providers in 2018 and 8% of listed providers in 2019 showed inaccuracies. However, we found substantial differences across markets, with a low of 54% accuracy for Medicaid listings in 2018. Commercial plans were consistently most accurate. In terms of adequacy, we found that more than 90% of listed providers were accessible within 15 days and 97% within 30 days, with Medicaid providing the highest rates of timely access. Overall, barriers to consumer access with regard to physical therapy appear to be primarily in the form of provider directory inaccuracies. High rates of inaccuracies raise concerns for patients as well as regulators. Ultimately, California is one of the most regulated states when it comes to network adequacy and access.
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来源期刊
World Medical & Health Policy
World Medical & Health Policy PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-
CiteScore
7.10
自引率
7.30%
发文量
65
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