Specialists' and primary care physicians' participation in medicaid managed care.
Specialists' and primary care physicians' participation in medicaid managed care.
复制标题
专科医生和初级保健医生参与医疗补助管理护理。
DOI：
10.1111/j.1525-1497.2001.01239.x
复制
发表时间：
2001
影响因子：
5.7
通讯作者：
Bindman,AB
中科院分区：
文献类型：
--
作者：
Backus,L;Osmond,D;Grumbach,K;Vranizan,K;Phuong,L;Bindman,AB
目的：比较专科医生和初级保健医生对加州医疗补助按服务收费和管理式医疗计划的参与情况。设计：横断面调查。参与者：按县和种族分层的概率样本，包括 1998 年在加州最大的 13 个县执业的 962 名专科医生和 713 名初级保健医生。测量和分析：我们使用邮寄问卷中的医生自我报告，比较专家与初级保健医生以及医生人口统计、执业环境、对医疗补助患者的态度以及对医疗补助管理式护理的态度对新医疗补助和新医疗补助管理式护理患者的接受程度。我们使用逻辑回归分析结果，加权数据代表 13 个县的初级保健医生和专科医生的总人口。 主要结果：专科医生与初级保健医生在其执业中拥有任何医疗补助患者的可能性相同（56% vs 56%；P=.9）。在接受任何新患者的医生中，专科医生比初级保健医生更有可能接受新的医疗补助患者，但更有可能仅限于接受医疗补助收费服务的患者。因此，与初级保健医生相比，专科医生接受新的医疗补助管理护理患者的可能性要小得多。在控制了医生人口统计、执业环境以及对医疗补助患者和医疗补助管理式护理的态度后，专家接受新的医疗补助管理式护理患者的可能性仍然要小得多。结论：医疗补助管理式护理的扩展可能会减少接触专家的机会，因为与医疗补助按服务收费的患者相比，专家不太可能接受新的医疗补助管理式护理患者。如果各州能够与团体模式 HMO 签订合同并招募少数族裔医生，那么就可以缓解就诊机会的减少。
OBJECTIVE:To compare specialist and primary care physician participation in California’s Medicaid fee-for-service and managed care programs.DESIGN:Cross-sectional survey.PARTICIPANTS:A probability sample stratified by county and by race of 962 specialist physicians and 713 primary care physicians practicing in the 13 largest counties in California in 1998.MEASUREMENTS AND ANALYSIS:We used physician self-report from mailed questionnaires to compare acceptance of new Medicaid and new Medicaid managed care patients by specialists versus primary care physicians and by physician demographics, practice setting, attitudes toward Medicaid patients, and attitudes toward Medicaid managed care. We analyzed results using logistic regression with data weighted to represent the total population of primary care and specialist physicians in the 13 counties.MAIN RESULTS:Specialists were as likely as primary care physicians to have any Medicaid patients in their practices (56% vs 56%;P=.9). Among physicians accepting any new patients, specialists were more likely than primary care physicians to be taking new Medicaid patients but were significantly more likely to limit their acceptance to only Medicaid fee-for-service patients. Thus, specialists were much less likely than primary care physicians to accept new Medicaid managed care patients. After controlling for physician demographics, practice settings, and attitudes toward Medicaid patients and Medicaid managed care, specialists remained much less likely to accept new Medicaid managed care patients.CONCLUSIONS:Expansion of Medicaid managed care may decrease access to specialists because specialists were less likely to accept new Medicaid managed care patients compared to Medicaid fee-for-service patients. Any decrease in access may be mitigated if states are able to contract with group model HMOs and to recruit minority physicians.