In Medicaid Managed Care Networks, Care Is Highly Concentrated Among A Small Percentage Of Physicians
In Medicaid Managed Care Networks, Care Is Highly Concentrated Among A Small Percentage Of Physicians
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DOI：
10.1377/hlthaff.2021.01747
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发表时间：
2022-05-01
期刊：
影响因子：
9.7
通讯作者：
Ndumele, Chima D.
中科院分区：
文献类型：
--
作者：
Ludomirsky, Avital B.;Schpero, William L.;Ndumele, Chima D.
各州越来越多地将医疗补助服务外包给私人管理式医疗计划。为了确保计划保持获得护理的机会，许多州制定了网络充分性标准，要求计划与最低数量的医生签订合同。在这项研究中，我们使用了四个州2015-17年期间的数据，以评估每个管理式医疗计划的提供者网络目录中列出的医生的医疗补助参与水平。我们发现，在我们的样本中，约有三分之一的门诊初级保健和专科医生与医疗补助管理式医疗计划签约，一年内不到10名医疗补助受益人。护理高度集中：25%的初级保健医生提供了86%的护理，25%的专家平均提供了75%的护理。我们的研究结果表明，目前的网络充分性标准可能无法反映实际的访问;需要新的方法来解释受益人的偏好和医生为医疗补助患者服务的意愿。
States have increasingly outsourced the provision of Medicaid services to private managed care plans. To ensure that plans maintain access to care, many states set network adequacy standards that require plans to contract with a minimum number of physicians. In this study we used data from the period 2015-17 for four states to assess the level of Medicaid participation among physicians listed in the provider network directories of each managed care plan. We found that about one-third of outpatient primary care and specialist physicians contracted with Medicaid managed care plans in our sample saw fewer than ten Medicaid beneficiaries in a year. Care was highly concentrated: 25 percent of primary care physicians provided 86 percent of the care, and 25 percent of specialists, on average, provided 75 percent of the care. Our findings suggest that current network adequacy standards might not reflect actual access; new methods are needed that account for beneficiaries' preferences and physicians' willingness to serve Medicaid patients.