Factors that influence the willingness of private primary care pediatricians to accept more Medicaid patients
Factors that influence the willingness of private primary care pediatricians to accept more Medicaid patients
复制标题
DOI：
10.1542/peds.110.2.239
复制
发表时间：
2002-08-01
期刊：
影响因子：
8
通讯作者：
Yudkowsky, B
中科院分区：
文献类型：
--
作者：
Berman, S;Dolins, J;Yudkowsky, B
Objective.根据联邦法律，州医疗补助计划有义务确保登记的儿童与同一地理区域的其他儿童一样获得同等程度的护理和服务。由于美国的大多数儿童接受私人初级保健医生的医疗保健，因此私人诊所初级保健儿科医生的参与对于履行这一平等获得义务至关重要。本研究的目的是记录各州私人诊所的初级保健儿科医生参与医疗补助的变化，并研究支付水平的影响，资本化医疗补助支付的流行程度，以及对参与的文书工作的关注。从3773名在私人诊所执业的初级保健儿科医生收集的调查数据与其他来源的医疗补助医生支付数据进行了分析。单因素分析和多元回归分析被用来检查支付水平的影响，流行的资本医疗补助支付，和文书工作的关注私人初级保健儿科医生参与国家医疗补助计划。结果显示，受访者参与医疗补助的州与州之间存在很大差异。单变量分析发现，参与随着州医疗补助支付水平的增加而增加，但随着初级保健资本支付的医疗补助注册者比例的增加以及文书工作的增加而减少。随着医生劳动力保持不变，回归分析表明，儿科医生参与医疗补助显着增加与医疗补助支付，但随着医疗补助患者的比例增加和文书工作的关注上升下降。这项研究发现，低支付，人头费和文书工作的关注都与低医疗补助参与初级保健办公室为基础的儿科医生。州政策制定者有必要解决这三个因素，以确保有足够的初级保健医生能力为参加州医疗补助计划的儿童提供适当的服务。
Objective. State Medicaid programs are obligated by federal law to ensure that enrolled children have access to care and services to the same extent as other children in the same geographic area. Because most children in the United States receive health care from private primary care physicians, participation by private, office-based primary care pediatricians is critical to meeting this equal access obligation. The objective of this study was to document variations in Medicaid participation of private office-based primary care pediatricians across states and to examine the effects of payment levels, prevalence of capitated Medicaid payment, and paperwork concerns on participation.Methods. Survey data collected from 3773 primary care pediatricians who practice in private office-based settings were analyzed with Medicaid physician payment data from other sources. Univariate analyses and a multiple regression were used to examine the effects of payment level, prevalence of capitated Medicaid payment, and paperwork concerns on private primary care pediatricians' participation in state Medicaid programs.Results. Results revealed substantial state-to-state variation in respondents' participation in Medicaid. Univariate analyses found that participation increased with state Medicaid payment levels but decreased as the proportion of Medicaid enrollees with primary care capitated payments rose and as paperwork concerns increased. With physician workforce held constant, a regression analysis showed that pediatrician participation in Medicaid increased significantly with Medicaid payment but decreased as the proportion of capitated Medicaid patients increased and as paperwork concerns rose.Conclusions. This study found that low payment, capitation, and paperwork concerns all relate to low Medicaid participation by primary care office-based pediatricians. It behooves state policy makers to address these 3 factors to ensure sufficient primary care physician capacity to serve appropriately children who are enrolled in state Medicaid programs.