What I learned reporting on Chinese-Americans’ access to care

It was easily the most memorable statement I heard while reporting on a recent project detailing unexpected problems with the Affordable Care Act rollout among Chinese American patients: “The health care system has a hierarchy, and it is inevitable that doctors pick patients based on the reimbursement rate and the complexity of their medical condition,” one doctor told me.

As the number of California Medicaid enrollees signing up for coverage has grown, the number of physicians hasn’t been able to meet the demand for care. In order to manage the workload, doctors are shifting more clinical duties to nurse practitioners and physician assistants.

To make it worse, California’s latest state budget retains a 10 percent cut in the state’s Medi-Cal reimbursement rates (Medi-Cal is California’s Medicaid program). The growing number of Medi-Cal patients, the low reimbursement rate, and the limited number of physicians make it very hard for Medi-Cal patients to find doctors. One primary care physician, Jing Xing Gao, said the discrepancy leads to the formation of a hierarchy.

“As more patients coming into my office – and I only have certain number of hours a day – filtering the pool of my patients is necessary,” Gao said. “Medi-Cal patients with low reimbursement rates and complicated medical conditions are definitely at the bottom of the health care system. Physicians are less willing to take them.”

The mission of Affordable Care Act is to ensure that more people have access to the affordable health insurance. And yet Dr. Gao’s comments seem to suggest it’s not meeting its promise for some groups.

To help other journalists working on similar projects, I have a few tips.

Get a broad range of perspectives

The Affordable Care Act is complex, and physicians and patients have different opinions. In order to dissect those, conducting a wide range of interviews is critical. Among providers, I interviewed six doctors including a primary care physician, a dermatologist, and a pediatrician.

Each of them looks at the same issue from different angles. The primary care doctor complained about having a hard time referring patients to specialists. Specialists defended themselves by saying that they need to maintain the quality of health care. The juxtaposition of differing opinions helps us better understand the issues in a more thorough way.

Taking initiative wins the day

I had a hard time finding Chinese Medi-Cal patients who were willing to be interviewed. I contacted multiple clinics and Chinese hospitals for referrals. Unfortunately, none of the patients were willing to speak with me. 

Instead of waiting for referrals, I decided to take some initiative. I sat in the waiting area at the East West Chinese Clinic in San Francisco looking for patients. I had friendly chats with them, asked them out for a coffee, and got to know them. After building trust, I told them about my project and its importance. When they expressed concerns about their privacy, I showed flexibility by offering anonymity.

Access is a growing challenge

Even though the shortage of physicians has always been a problem, the context is shifting now.  We need to look at these existing problems in the new context of health reform. The Affordable Care Act may allow more patients into the healthcare system, but the imbalance between the number of physicians willing to accept Medi-Cal patients and the skyrocketing demand for health care is leading to unprecedented access challenges for many Chinese Americans.

Courtesy image via Na Li.