Primary Care Office Policies Regarding Care of Uninsured Adult Patients

Authors

  • Thomas P. O'Toole MD,

    Corresponding author
    1. Received from the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University (TPO), Baltimore, Md; and the Allegheny County Health Department, (PMS, BRD), Pittsburgh, Pa.
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  • Peter M. Simms MSW,

    1. Received from the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University (TPO), Baltimore, Md; and the Allegheny County Health Department, (PMS, BRD), Pittsburgh, Pa.
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  • Bruce W. Dixon MD

    1. Received from the Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University (TPO), Baltimore, Md; and the Allegheny County Health Department, (PMS, BRD), Pittsburgh, Pa.
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Address correspondence and reprint requests to Dr. O'Toole: Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, 2024 E. Monument St., Room 2-513, Baltimore, MD 21205 (e-mail: totoole@jhmi.edu).

Abstract

OBJECTIVE: To describe primary care office policies regarding care of uninsured patients.

DESIGN: Telephone survey of all adult primary care sites advertising in the area telephone directory. Sites were defined by ownership status, number of physicians, use of physician-extenders, and location. Policies assessed were whether the site was accepting new uninsured patients, billing policies, the availability of free or discounted care, and payment plans.

SETTING: Allegheny County, Pennsylvania.

PARTICIPANTS: Of the 359 sites identified, 240 (66.9%) responded, representing 794 physicians. Survey respondents included receptionists (40.4%), office managers (36.2%), and physicians (22.9%).

RESULTS: While the majority of all sites reported accepting new patients without health insurance (87.5%), policies regarding these patients varied significantly by ownership status and the number of physicians. Sites with 3 or fewer physicians were more likely to accept uninsured patients. Self-owned practices were more likely to require payment at the time of service, and provide discounted care, free care, and payment plans compared with hospital/health system practices or multisite group practices.

CONCLUSIONS: Willingness to accept uninsured patients does not always equate to affordable or accessible care. Office policies have the potential to be substantial obstacles to primary care.

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