Physician participation in Medicaid revisited
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1Center for Health Economics Research, Waltham, MA 12154.
Abstract:
Medicaid cut-backs during the Reagan Administration may have combined with other factors to affect physicians' willingness to participate in Medicaid. The author analyzed participation rates for two comparable groups of physicians: one group surveyed in 1977-78 and the other surveyed in 1984-85. Over this time period, there was a small, but statistically significant, decline in Medicaid participation rates (from 12.1-9.5%). Regression analysis showed, however, that physicians remain sensitive to important policy variables, such as fee levels and eligibility criteria. Physicians treat significantly more Medicaid patients when Medicaid fees are relatively high and when there is a relatively large number of people eligible for Medicaid in their area. These findings reinforce recent Congressional mandates to expand Medicaid eligibility and to raise payment levels for obstetric and pediatric services. Increased participation on the part of urban physicians, however, may be limited by the residential segregation of many Medicaid eligible people in the inner city.
Insights
Physician participation in Medicaid slightly declined between 1977-85, but remains sensitive to policy factors like fees and eligibility. Increasing these can boost physician engagement with the program.
Area of Science:
- Health Services Research
- Health Economics
- Public Health Policy
Background:
- Medicaid participation rates among physicians are crucial for ensuring access to care for low-income populations.
- Potential impacts of policy changes, such as the Reagan Administration's Medicaid cut-backs, on physician participation warrant investigation.
Purpose of the Study:
- To analyze trends in physician participation in Medicaid between the late 1970s and mid-1980s.
- To identify key policy variables influencing physicians' decisions to treat Medicaid patients.
Main Methods:
- Comparative analysis of physician participation rates from two survey periods: 1977-78 and 1984-85.
- Regression analysis to assess the impact of policy variables (fee levels, eligibility criteria) on participation.
Main Results:
- A statistically significant, though small, decline in Medicaid participation rates was observed (12.1% to 9.5%).
- Physician participation was positively associated with higher Medicaid fee levels and greater numbers of eligible individuals in their service area.
- Urban physicians' participation may be constrained by the residential segregation of Medicaid-eligible populations.
Conclusions:
- Despite a slight decline, physician participation in Medicaid is responsive to policy levers.
- Findings support policy recommendations to increase Medicaid eligibility and payment rates, particularly for essential services.
- Addressing geographic and residential segregation is important for improving access to care for urban Medicaid beneficiaries.