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Related Experiment Videos

Using Medicaid claims data to evaluate a large physician fee increase

M H Fox1, K L Phua

  • 1Policy and Health Statistics Administration, Maryland Department of Health and Mental Hygiene, Baltimore, MD 21201.

Health Services Research
|August 1, 1994
PubMed
Summary

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.

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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.

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  • 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.