Program to Use Mystery Shoppers to Probe Doctors Scrapped


Findings Could be Valuable and Informative, Say Others

In 2014, the Affordable Care Act will provide insurance coverage to millions more Americans, in part by expanding eligibility for Medicaid, which experts believe will place a much greater burden on the health care system unless problems surrounding the availability of care are addressed. The findings from the "mystery shopper" initiative could have helped determine where the biggest problems lie.

"My guess is that it will find that Medicare patients have some problems, but that Medicaid patients have very big problems getting doctors, especially in states with low reimbursement rates," said Dean Baker, co-director of the Center for Economic and Policy Research in Washington, D.C.

Other experts say the program would have helped confirm how severe the shortage of primary care physicians is and where the most critical shortages are. There have been disparities between research findings and government data on access to care.

One study published in the May issue of the New England Journal of Medicine done by the Massachusetts Medical Society, for example, found that more than half of primary care practices were not accepting patients. For those practitioners who were taking new patients, the average wait time for an appointment was as long as 48 days.

"I view the [mystery shopper] program as an important empirical study," said Dr. A. Mark Fendrick, professor of health management and policy at the University of Michigan School of Public Health in Ann Arbor. "Either our fear of lack of [primary care physician] access will be confirmed and policies implemented to overcome the shortage, or lessened if access is adequate."

"It is the only way to get a truly accurate measurement of current access to primary care, as it can isolate the impact of insurance status on access," said Dr. Karin Rhodes, director of the Division of Emergency Care Policy and Research at the University of Pennslvania in Philadelphia.

Patients With Private Insurance Have Problems Seeing Doctors Too

Rhodes is also co-author of a 2005 study that also used a "mystery shopper" approach to determine whether the type of insurance affected the ability to get a doctor's appointment.

Callers who said they had private insurance got an appointment easier than those who said they had public insurance, but most callers with private insurance who indicated they had a life-threatening problem still couldn't get an appointment.

A new study published in the current issue of the journal Archives of Internal Medicine found that the number of physcians accepting private insurance decreased from 93.3 percent in 2005 to 87.8 percent in 2008.

Experts hope that the government will follow through on efforts to improve patients' access to care.

"Access to health care is a matter of life and death," said Robert Field, professor of management and policy at Drexel University School of Public Health in Philadelphia. "Few national needs are more urgent."

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