Missed appointments and Medicaid managed care
B. A. Majeroni, T. Cowan, J. Osborne and R. P. Graham
State University of New York at Buffalo, USA. bmajeron@ubmedb.buffalo.edu
OBJECTIVES: To compare the demographic characteristics of patients who miss
appointments with those who do not and to identify subgroups who would
benefit from specific interventions for improving attendance. DESIGN:
Retrospective cohort study of an 18-month period. SETTING: An urban primary
care practice. PATIENTS: A random sample (N = 477) of patients who were
seen at least twice during the study period. MAIN OUTCOME MEASURES: Number
of missed visits and kept visits, insurer, age, sex, race, ZIP code, and
diagnoses. RESULTS: Of the established patients, 48% missed 1 or more
visits. Patients in managed care programs, private and Medicaid, were
likely to have missed more visits during the study period than those not in
managed care programs (P < .001). Medicaid managed care patients had
also scheduled more visits. Significantly higher rates of missed
appointments were found in patients aged 19 to 35 years (P = .02), blacks
(P < .001), patients in Medicaid managed care programs (P < .001),
and patients who scheduled more visits (P < .001). After adjusting for
age, race, and sex, Medicaid managed care insurance remained a significant
(P < .01) predictor of rate of missed appointments. CONCLUSIONS:
Patients in managed care programs missed more appointments. Patients in
Medicaid managed care programs scheduled more appointments and had higher
rates of missed appointments than their counterparts in other insurance
groups.
