Equity in access to outpatient rehabilitation services for children with traumatic brain injury and public insurance

Abstract

Objective: Identify insurance-based disparities in access to outpatient rehabilitation services for children. Design: Audit study using paired telephone calls by callers posing as mother of a child with history of severe traumatic brain injury (TBI) seeking outpatient rehabilitation services. Setting: Outpatient rehabilitation service clinics in Washington State Participants: 195 Physical Therapy (PT), 109 Occupational Therapy (OT), 102 Speech Therapy (ST) and 11 Rehabilitation Medicine clinics Interventions: None Main outcome measures: Acceptance of public insurance and wait time in work days until the next available appointment. Results: Therapy clinics were more likely to accept private versus public insurance (incidence rate ratio (IRR) for PT 1.33 (95% confidence interval (CI) 1.22-1.44), for OT 1.40 (95% CI 1.24-1.57), and for ST 1.42 (95% CI 1.25-1.62), but there was no significant difference for Rehabilitation Medicine clinics (IRR 1.10, 95% CI 0.90-1.34). The difference in median wait time between clinics that accepted public versus only private insurance was 4 business days for PT and 15 days for PT (p ≤ .001) but not significantly different for OT or Rehabilitation Medicine. When adjusting for urban and multidisciplinary status, the wait at clinics accepting public insurance was 59% longer for PT (95% CI 39-81%), 18% longer for OT (95% CI 7-30%) and 107% longer for ST (95% CI 87-130%) than at clinics accepting only private insurance. Conclusion: There are insurance-based disparities in access to outpatient rehabilitation services. Therapy clinics offering services for children with TBI were less likely to offer appointments for callers with public versus private insurance. Therapy clinics accepting public insurance had longer wait times than clinics that accepted only private insurance.