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Access to physicians' services for vulnerable Medicare beneficiaries
1Center for Health Economics Research, Waltham, MA 02452-8414, USA.
Abstract:
This article examines whether changes in physician reimbursement under the Medicare Fee Schedule (MFS) had differential impacts on access to care for vulnerable and nonvulnerable Medicare beneficiaries. The quasi-experimental research design takes advantage of cross-sectional differences in the magnitude of the MFS impact on payments. We selected a stratified random sample to ensure adequate representation of vulnerable group members and constructed service-specific measures of the MFS payment change. While we found few effects on access attributable to the MFS, we did find substantial utilization gaps between vulnerable and nonvulnerable subpopulations for primary care services, as well as for high-cost procedures during episodes of care for acute myocardial infarctions.
Insights
Changes to Medicare physician reimbursement did not significantly affect care access. However, substantial utilization gaps persist between vulnerable and nonvulnerable Medicare beneficiaries for primary care and high-cost procedures.
Area of Science:
- Health Services Research
- Health Economics
- Public Health Policy
Background:
- Physician reimbursement policies, such as the Medicare Fee Schedule (MFS), can influence healthcare access.
- Understanding differential impacts on vulnerable populations is crucial for equitable healthcare delivery.
Purpose of the Study:
- To investigate if Medicare Fee Schedule (MFS) payment changes differentially affected access to care for vulnerable versus nonvulnerable Medicare beneficiaries.
- To identify disparities in healthcare utilization between these groups.
Main Methods:
- Utilized a quasi-experimental research design leveraging cross-sectional payment variations.
- Employed a stratified random sample to ensure adequate representation of vulnerable Medicare beneficiaries.
- Developed service-specific measures of MFS payment changes.
Main Results:
- Few significant effects of MFS changes on overall access to care were identified.
- Substantial utilization gaps were observed between vulnerable and nonvulnerable subpopulations.
- Disparities were noted in primary care services and high-cost procedures during acute myocardial infarction episodes.
Conclusions:
- Medicare Fee Schedule (MFS) payment adjustments showed limited impact on healthcare access.
- Significant and persistent utilization gaps exist for vulnerable Medicare beneficiaries.
- Targeted interventions may be needed to address disparities in care for vulnerable populations.