Equity in Access to Outpatient Rehabilitation Services For Children With Traumatic Brain Injury and Public Insurance

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Research Objectives

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 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

Not applicable.

Main Outcome Measure(s)

Offer of appointment at clinic and wait time in work days until the next available appointment.

Results

Therapy clinics were more likely to accept private versus public insurance (relative risk (RR) 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 (RR 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

Conclusions

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.

Key Words

Health Services Accessibility, Rehabilitation Centers, Healthcare Disparities, Disabled Children

Disclosures

None disclosed.

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