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Auditing access to outpatient rehabilitation services for children with traumatic brain injury and public insurance in Washington State


Fuentes M, Thompson L, Quistberg A, Wren, H, Rhodes K, Kartin D, Kerfeld C, Apkon S, Rowhani-Rhabar A, Rivara F



Publication Info:

Archives of Physical Medicine and Rehabilitation, in press:


OBJECTIVE: Identify insurance-based disparities in access to outpatient pediatric neurorehabilitation services. DESIGN: Audit study, with paired calls where callers posed as a mother seeking services for a simulated child with history of severe traumatic brain injury (TBI) and public or private insurance. SETTING: Outpatient rehabilitation clinics in Washington State PARTICIPANTS: 195 physical therapy clinics (PTc), 109 occupational therapy clinics (OTc), 102 speech therapy clinics (STc) and 11 rehabilitation medicine clinics INTERVENTIONS: None MAIN OUTCOME MEASURES: Acceptance of public insurance, business days until the next available appointment. RESULTS: Therapy clinics were more likely to accept private versus public insurance (relative risk (RR) for PTc 1.33 (95% confidence interval (CI) 1.22-1.44), OTc 1.40 (95% CI 1.24-1.57), and STc 1.42 (95% CI 1.25-1.62), with no significant difference for rehabilitation medicine (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 PTc and 15 days for STc (p = .001) but not significantly different for OTc or rehabilitation medicine. When adjusting for urban and multidisciplinary clinic 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. Distance to clinics varied by discipline and area within the state. CONCLUSION: Therapy clinics were less likely to accept public versus private insurance. Therapy clinics accepting public insurance had longer wait times than clinics that accepted only private insurance. Rehabilitation professionals should attempt to implement policy and practice changes to promote equitable access to care.

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