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Using Medicaid claims data to evaluate a large physician fee increase
1Policy and Health Statistics Administration, Maryland Department of Health and Mental Hygiene, Baltimore, MD 21201.
Objective:
This study demonstrates the use of Medicaid claims data in order to evaluate a threefold fee increase in physician fees for deliveries ($265 to $795), which the Maryland Medicaid program implemented in 1986.
Data Sources And Study Setting:
The study used Maryland Medicaid claims data for years of service 1985-1988, and was done at the Maryland Department of Health and Mental Hygiene with the help of a Robert Wood Johnson, Health Care Financing and Organization (HCFO) grant.
Study Design:
Overall, our design is that of a pre-test, post-test with multiple observation points both before and after the fee increase. We measured participation in three ways, corresponding to three different units of analysis. With the county-quarter year as unit of analysis, we followed a panel of providers over 16 quarters for each county in the state to determine changes in the number of delivering providers. With the individual provider as the unit of analysis, we identified effects on their Medicaid caseload between years that may have been influenced by the fee increase. Finally, we looked at continuously enrolled Medicaid women who delivered to determine the effects of the fee increase on site and volume of prenatal care.
Data Collection/Extraction Methods:
Analytic files for each unit of analysis were compiled from previously extracted Medicaid claims files using standard statistical software packages.
Principal Findings:
Using techniques described, we were able to get an in-depth picture of overall responsiveness to the intervention. We found a moderate influence of the fee increase on overall participation, less than what we would have predicted.
Conclusions:
Administrative data can be used to construct efficient, yet sophisticated evaluations of major policy changes. Findings from our evaluation suggest a moderate effect of the fee increase on overall participation. However, raising fees to the level of private third party payers does not in itself guarantee equal access to private physician health care for Medicaid mothers.
Insights
Maryland Medicaid increased physician fees for deliveries in 1986. This study found the fee increase had a moderate effect on provider participation, but did not ensure equal access to care for Medicaid mothers.
Area of Science:
- Health Services Research
- Public Health Policy
- Healthcare Economics
Background:
- The Maryland Medicaid program implemented a threefold physician fee increase for delivery services in 1986, raising fees from $265 to $795.
- Evaluating the impact of such policy changes on provider behavior and patient access is crucial for healthcare system optimization.
Purpose of the Study:
- To assess the impact of a significant physician fee increase on provider participation and patient access to care within the Maryland Medicaid program.
- To demonstrate the utility of Medicaid claims data for evaluating major healthcare policy interventions.
Main Methods:
- Utilized Maryland Medicaid claims data spanning 1985-1988, encompassing pre- and post-intervention periods.
- Employed a pre-test, post-test design with multiple observation points to analyze changes in the number of delivering providers, individual provider caseloads, and prenatal care utilization.
- Data analysis involved compiling analytic files from Medicaid claims using standard statistical software.
Main Results:
- The fee increase demonstrated a moderate influence on overall provider participation, which was less than initially predicted.
- Analysis indicated that aligning Medicaid physician fees with private third-party payers did not automatically guarantee equitable access to private physician healthcare for Medicaid-enrolled mothers.
Conclusions:
- Administrative data, such as Medicaid claims, can be effectively leveraged for sophisticated evaluations of significant policy changes.
- While fee increases can moderately impact provider participation, they may not be sufficient on their own to ensure equal healthcare access for vulnerable populations.
- Further policy considerations are needed to address systemic barriers to healthcare access for Medicaid beneficiaries beyond fee adjustments.