Auditing Access to Outpatient Rehabilitation Services for Children With Traumatic Brain Injury and Public Insurance in Washington State.
Molly M Fuentes, Leah Thompson, D Alex Quistberg and 7 others
PMID 28126353WHAT IT FOUND
Children with public insurance faced longer waits and lower acceptance rates for outpatient rehabilitation in Washington State.
Speech therapy showed the largest disparities, with median waits of 20 days for public insurance versus 5 days for private insurance.
Key findings
01Public insurance was accepted by fewer therapy clinics than private insurance, with speech therapy clinics showing the lowest acceptance rates.
02Median wait times for initial appointments were significantly longer for callers with public insurance compared to private insurance, particularly in speech therapy.
03Adjusted analysis showed wait times were 107% longer for speech therapy, 59% longer for physical therapy, and 18% longer for occupational therapy at clinics accepting public insurance.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
Single-state study (Washington), limiting generalizability to states with different insurance landscapes. Simulated child scenario may not capture complexities of real-world referrals. Did not adjust for clinic size, provider count, or reputation, which can affect wait times. Excluded clinics focusing on musculoskeletal impairments, potentially undercounting access. Focused only on wait time to initial evaluation, not ongoing treatment access.
The easy way to misread this
Do not assume these disparities apply equally across all disciplines or regions. Speech therapy showed significantly worse access than physical or occupational therapy, and urban areas had more pronounced insurance-based disparities than rural areas. The study measured access to initial evaluation, not long-term treatment availability.