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Medicaid physician fees and use of physician and hospital services
1Agency for Health Care Policy and Research, U.S. Department of Health and Human Services, Rockville, MD 20852.
Abstract:
This paper examines how physician fees affect use of physician and hospital services under the Medicaid program. Using data from the 1987 National Medical Expenditure Survey (NMES), it examines how Medicaid physician fee levels affect beneficiaries' probability of using ambulatory physician services, the site at which ambulatory physician care is usually received, and how that site affects level of use and probability of hospital admission. The results indicate that low Medicaid fees hamper access to office-based physicians and encourage use of hospital outpatient departments and emergency rooms. They also indicate that having an office-based doctor as a usual source of ambulatory physician care is associated with a higher frequency of visits and a lower probability of having an inpatient hospitalization.
Insights
Low Medicaid physician fees reduce access to office-based care, increasing reliance on hospital outpatient services. Having a regular doctor improves visit frequency and lowers hospitalization risk for beneficiaries.
Area of Science:
- Health Services Research
- Medical Economics
- Public Health Policy
Background:
- Physician reimbursement rates significantly influence healthcare utilization patterns.
- Medicaid beneficiaries often face access barriers to timely and appropriate medical care.
- Understanding the impact of physician fees is crucial for optimizing healthcare delivery within public programs.
Purpose of the Study:
- To investigate the relationship between Medicaid physician fee levels and the utilization of physician and hospital services.
- To determine how fee levels affect the choice of care site for ambulatory services.
- To assess the impact of the usual source of care on healthcare use and hospital admission rates.
Main Methods:
- Analysis of data from the 1987 National Medical Expenditure Survey (NMES).
- Examination of Medicaid physician fee levels' effect on the probability of using ambulatory physician services.
- Assessment of how the site of ambulatory care influences service use and hospital admission probability.
Main Results:
- Lower Medicaid physician fees were associated with reduced access to office-based physicians.
- Reduced access led to increased utilization of hospital outpatient departments and emergency rooms.
- Having an office-based physician as a usual source of care correlated with higher visit frequency and lower hospitalization probability.
Conclusions:
- Medicaid physician fee levels are a significant determinant of healthcare seeking behavior and site of care.
- Policies aimed at increasing physician fees may improve access to primary care and reduce costly hospitalizations.
- Establishing a usual source of ambulatory care is linked to better health outcomes and more efficient healthcare resource utilization.