Geographic variation in physicians' fees. Payments to physicians under Medicare and Medicaid

To study geographic differences in physician fees recognized by the Medicare and Medicaid programs, we analyzed physician reimbursement rates at the national, regional, state, and county levels. The results indicate that nationally, Medicaid specialist fees are 77% of Medicare specialist fees. Meidcare specialist fees in metropolitan areas are 23% higher than those in nonmetropolitan areas, but there are no differences under Medicaid. State Medicare specialist fees varied from 73% to 132% of the national Medicare average, while Medicaid specialist fees ranged from 49% to 179% of the national Medicaid average. State Medicaid fees for specialists ranged from 39% to 100% of Medicare specialist fees. These results indicate that under national health insurance, fees set at national or statewide levels could have notable effects on physician remuneration in some localities.