Physician Participation in State Medicaid Programs

Sloan, Frank A.; Mitchell, Janet B.; Cromwell, Jerry

doi:10.2307/145253

Cited by 181 publications

(150 citation statements)

References 7 publications

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“…Several studies have found significant positive correlations between relative Medicaid fees and both Medicaid participation and caseloads among office-based physicians in general (Sloan, Mitchell, and Cromwell 1978;Hadley 1979;Held and Holahan 1985;Mitchell 1991;Adams 1994) and pediatricians in particular (Perloff, Kletke, and Neckerman 1986;Margolis et al 1992). However, other studies have shown that much of the increase simply reflects a shift of patients from public sites (e.g., public health departments and community health clinics) to private physicians' offices (Long, Settle, and Stuart 1986;Wade 1992;Cohen and Cunningham 1993;Baker and Royalty 1997;Gruber, Adams, and Newhouse 1997).…”

Section: Previous Researchmentioning

confidence: 99%

The Use of EPSDT and Other Health Care Services by Children Enrolled in Medicaid: The Impact of OBRA'89

Gavin

Adams

Herz³

et al. 1998

Milbank Quarterly

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To increase the participation of Medicaid children in the Early and Periodic Screening, Diagnosis and Treatment (EPSDT) program and to improve their health, Congress included several provisions in the Omnibus Budget Reconciliation Act of 1989 (OBRA’89) that addressed problematic program features. The impact of these provisions on children's health service use was investigated in a study funded by the Health Care Financing Administration. After conducting site visits to four states, the authors analyzed claims data for the children residing there and found evidence that, in 1992, these states placed a higher priority on improving the effectiveness of EPSDT than they did before 1989. The states’ efforts to expand the EPSDT provider base and to enhance outreach and service provision were either directly or indirectly inspired by OBRA’89. The authors also found evidence of a significant impact on provider participation and caseloads and on children’s use of both preventive care and diagnostic and treatment services. However, the effects were modest in comparison to the size of the progress that is required.

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Section: Previous Researchmentioning

confidence: 99%

The Use of EPSDT and Other Health Care Services by Children Enrolled in Medicaid: The Impact of OBRA'89

Gavin

Adams

Herz³

et al. 1998

Milbank Quarterly

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“…First, it is not clear whether a 10 percent bonus on Medicare payments is sufficient to attract or retain physicians in HMSAs (242). Although physicians have been found to respond to increased Medicare and Medicaid reimbursement by accepting more Medicare and Medicaid patients or by providing increased care to patients they already see (161,266,395,508,564), the strength of the incentive will vary depending on the Medicare or Medicaid caseload of the physician. The increase in payment rates should result in increased income for many physicians, however.…”

Section: Medicare Bonus Paymentsmentioning

confidence: 99%

Health Care in Rural America

Ahearn¹

1990

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An advisory panel, chaired by Dr. James Bernstein of the North Carolina Office of Rural Health and Resource Development, provided guidance and assistance during the assessment. Also, three public meetings were held (in Scottsdale, Arizona; Bismarck, North Dakota; and Meridian, Mississippi) to provide OTA with the opportunity to discuss specific rural health topics with local and regional health practitioners, administrators, and officials. Site visits to local facilities were conducted in association with these activities. A number of individuals from both government and the private sector provided information and reviewed drafts of the report.OTA gratefully acknowledges the contribution of each of these individuals. As with all OTA reports, the content of the assessment is the sole responsibility of OTA and does not necessarily constitute the consensus or endorsement of the advisory panel or the Technology Assessment Board. Key staff responsible for the assessment were Elaine Power, Lawrence Miike, Maria Hewitt, Tim Henderson, Leah Wolfe, Marc Zimmerman, and Rita Hughes. The panel does not, however, necessarily approve, disapprove, or endorse this xeport. OTA assumes full responsibility for the report and the accuracy of its contents.iv

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“…I apply the Sloan, Mitchell, and Cromwell (1978) model of a mixed economy with private and public payers to this question and predict that physicians affected by the implementation of SCHIP should decrease the quantity of medical services they provide and increase their participation in the public insurance program. This results from the fact that, for a portion of the physicians who were not previously participating in the public insurance program, the implementation of SCHIP changes the marginal patient from one covered by private insurance to one covered by the lower-reimbursing government program.…”

Section: Introductionmentioning

confidence: 99%

The Doctor Might See You Now: The Supply Side Effects of Public Health Insurance Expansions

Garthwaite¹

2011

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In the United States, public health insurance programs cover over 90 million individuals. Changes in the scope of these programs, such as the Medicaid expansions under the recently passed Patient Protection and Affordable Care Act, may have large effects on physician behavior. This study finds that following the implementation of the State Children's Health Insurance Program, physicians decreased the number of hours spent with patients, but increased their participation in the expanded program. Suggestive evidence is found that this decrease in hours was a result of shorter office visits. These findings are consistent with the predictions from a mixed-economy model of physician behavior with public and private payers and also provide evidence of crowd out resulting from the creation of SCHIP.

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Physician Participation in State Medicaid Programs

Cited by 181 publications

References 7 publications

The Use of EPSDT and Other Health Care Services by Children Enrolled in Medicaid: The Impact of OBRA'89

The Use of EPSDT and Other Health Care Services by Children Enrolled in Medicaid: The Impact of OBRA'89

Health Care in Rural America

The Doctor Might See You Now: The Supply Side Effects of Public Health Insurance Expansions

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