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Having health insurance won't help you get a doctor's appointment

If finding out that you have cancer isn’t bad enough, a new study concludes that you may have difficulty scheduling appointments for your treatment, even if you have adequate health insurance.

At the annual meeting of the American Society of Clinical Oncology in Chicago in June, researchers from the University of Pennsylvania reported on a study that found seven out of 10 cancer patients with an advanced stage of the disease had difficulty scheduling doctor appointments for follow-up cancer care.

health insurance and doctor appointmentsTo conduct the study, researchers posed as patients newly diagnosed with inoperable liver cancer, both with and without health insurance coverage. They attempted to make appointments for oncology visits at 160 hospitals throughout the United States. More than a third of the time, the researchers had to make multiple calls. In almost a quarter of the cases, they failed to reach staff, even after three attempts.

"Although health care reform is likely to expand health insurance coverage to more Americans, our research shows that even with health insurance, patients face barriers when they try to access cancer care," says Keerthi Gogineni, an oncologist at the University of Pennsylvania's Abramson Cancer Center and lead author of the study,

Researchers found that uninsured patients were more successful at getting appointments than Medicaid or privately insured patients. Those posing as uninsured patients were able to make appointments about 29 percent of the time, while the rate was a little more than 22 percent for those pretending to have private health insurance. It was just over 17 percent for those posing as Medicaid patients. However, Gogineni says the trend favoring uninsured over insured patents was not large enough to be statistically significant. Both groups faced serious obstacles to care.

Electronic medical records may help

Gina Russo, a licensed clinical social worker and director of the Information Resource Center for The Leukemia & Lymphoma Society, says the study's findings are not surprising. Like Gogineni, Russo hopes making appointments will become easier next year when, under the massive health care reform that Congress enacted in March 2010, all medical records are to be available electronically.

Lots of times, she says, patients face delays because an oncologist or another specialist can't see them without seeing all of their records. "The adoption of electronic medical health records should eliminate one of the barriers that doesn't allow cancer patients to get the appointments they require quickly," she says.

However, Russo fears that other barriers may not be overcome as easily, if at all. Prevention programs and early detection have helped lower some cancer rates and treatments have improved, allowing many people to live longer with the disease. As a result, "medical offices are seeing large numbers of patients,” Russo says. “The office staff doesn't have the time to call the imaging center on your behalf to make sure your studies are sent over."

In the past, she says, office staff members may have done more to advocate for patients, "but because of the sheer volume" that’s no longer possible.

Also, in some cases, cancer patients with health insurance can be hindered by the need to get referrals from their family physician. Often the family physician is not the one diagnosing the cancer. "It just adds another layer and the cancer patients, who are likely sick and overwhelmed and exhausted, find the barriers become so large they don't pursue the necessary treatment," Russo says.

Patients have to be advocates

Finding good medical coverage and affordable health insurance rates may not be enough to guarantee access to care. There are steps you can take to improve your ability to get timely treatment. To speed the process you can:

  • Ask for copies. Every time you get a scan, a lab test or a report from your doctor, ask for a copy for your records, Russo says. "Maintain an ongoing file of your tests and labs rather than… obtaining them as you need them."
  • Plan ahead. Make your appointments a week or two in advance. That should give the doctor's office enough time to gather your records.
  • Seek help. Many health care systems today employ patient advocates or navigators who help cancer patients work through the maze of follow-up care, Russo says. Also, organizations such as The Leukemia & Lymphoma Society and The American Cancer Society have staff members who can help, if you reach out to them.
  • Be tenacious. If you're denied an appointment, don't let it go. Ask to speak with the office manager or the head nurse and present your case. Often the person answering the phone doesn't have the authority to override the computerized scheduler, but someone else in the office does.


More from Beth Orenstein here

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