The Limits of Marginal Economic Incentives in the Medicaid Program: Concerns and Cautions

Fanning, Thomas; Alteriis, Martin de

doi:10.1215/03616878-18-1-27

Cited by 16 publications

(8 citation statements)

References 11 publications

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“…Although the size of Medicaid payments does not appear to enhance such connections for insured residents, larger Medicaid payments do promote insured adults' use of physician services. This finding is consistent with the mixed, but generally weak, effects of Medicaid fees on physician participation and volume of physician visits found in other studies (Mitchell 1991;Fanning and de Alteriis 1993;Adams 1994;Coburn, Long, and Marquis 1999). Thus, the answer to our third research question is that the effect of support for the community's safety net varies by health insurance status, with greater support translating into better potential access for the uninsured and better realized access for insured residents.…”

Section: Discussionsupporting

confidence: 91%

Effects of Community Factors on Access to Ambulatory Care for Lower-Income Adults in Large Urban Communities

Brown¹,

Davidson²,

Yu³

et al. 2004

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This study examines the effects of community-level and individual-level factors on access to ambulatory care for lower-income adults in 54 urban metropolitan statistical areas in the United States. Drawing on a conceptual behavioral and structural framework of access, the authors developed multivariate models for insured and uninsured lower-income adults to assess the adjusted effects of community-and individual-level factors on two indicators of access: having a usual source of care, and having at least one physician visit in the past year. Several community factors influenced access, but they did so differently for insured and uninsured adults and for the two measures of access used. The findings of this study confirm that public policies and community environment have measurable and substantial impacts on access to care, and that expanded public resources, such as Medicaid payments and safety-net clinics, can lead to measurable improvements in access for vulnerable populations residing in large urban areas.

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Section: Discussionsupporting

confidence: 91%

Effects of Community Factors on Access to Ambulatory Care for Lower-Income Adults in Large Urban Communities

Brown¹,

Davidson²,

Yu³

et al. 2004

INQUIRY

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show abstract

“…Evidence concerning the importance of Medicaid reimbursement rates as a driver of access to primary care services for the poor is also substantially equivocal. Several studies suggest that fee increases have small to moderate effects on primary care physicians' Medicaid participation levels (Berman et al 2002;Coburn, Long, and Marquis 1999;Fanning and de Alteriis 1993;Gray, Vandergrift, and McAllister 2015;Perloff, Kletke, and Fossett 1995;Perloff et al 1997;Wilk 2013;Zuckerman et al 2004), and emerging studies on the effects of the fee bump itself are similarly mixed (Crawford and McGinnis 2015;Decker 2016;MACPAC 2015;Mulcahy et al 2016;Polsky et al 2015). Other factors such as delays in payment, administrative burden, and perceptions of patient difficulty might be equally or more consequential Nichols 2005, Cunningham andO'Malley 2009;Davidson 1982;GAO 2011;Hadley 1979;Long 2013;Spaulding 2015;Wilk 2013).…”

Section: Introductionmentioning

confidence: 99%

Expanding Medicaid Access without Expanding Medicaid: Why Did Some Nonexpansion States Continue the Primary Care Fee Bump?

Wilk

Evans²,

Jones³

2018

Journal of Health Politics, Policy and Law

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Six states that have rejected the Patient Protection and Affordable Care Act's (ACA) Medicaid expansion nonetheless extended the primary care "fee bump," by which the federal government increased Medicaid fees for primary care services up to 100 percent of Medicare fees during 2013-14. We conducted semistructured interviews with leaders in five of these states, as well as in three comparison states, to examine why they would continue a provision of the ACA that moderately expands access at significant state expense while rejecting the expansion and its large federal match, focusing on relevant economic, political, and procedural factors. We found that fee bump extension proposals were more successful where they were dissociated from major national policy debates, actionable with the input of relatively few stakeholder entities, and well aligned with preexisting policy-making structures and decision trends. Republican proposals to cap or reduce federal funding for Medicaid, if enacted, would compel states to contain program costs. In this context, states' established decision-making processes for updating Medicaid fee schedules, which we elucidate in this study, may shape the future of the Medicaid program.

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“…Most recent studies of fee increases have found that their average effects on PCP participation are only small to moderate (Berman et al 2002;Coburn, Long, and Marquis 1999;Fanning and de Alteriis 1993;Perloff, Kletke, and Fossett 1995;Perloff et al 1997;Wilk 2013;Zuckerman et al 2004), though effects will be more significant for some physicians than for others (Wilk 2013). Thus, quite substantial fee increases may be required to achieve meaningful improvements in PCP participation.…”

Section: Introductionmentioning

confidence: 99%

To Extend or Not to Extend the Primary Care “Fee Bump” In Medicaid?

Wilk

Jones²

2014

Journal of Health Politics, Policy and Law

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Policy makers and researchers are eager to learn the effects of the Patient Protection and Affordable Care Act of 2010 (ACA) and its many provisions, but to date, they have been frustrated by the dearth of robust evidence on the ACA's true impacts on important health care and patient outcomes (e.g., access to primary care services). The present limitations of evidence, often a consequence of delays and inconsistencies in the law's implementation, have begun to affect policy making in the ACA's wake. In this article, we consider the debates among state and federal policy makers about whether to extend the ACA's so-called fee bump provision, whereby Medicaid fees for primary care services were increased to 100 percent of Medicare levels during 2013 and 2014. We describe the difficulties state Medicaid programs have experienced in implementing the fee bump, as well as how the resulting evidence gap and the broader political context have shaped the deliberations. To conclude, we identify policy alternatives and other factors policy makers should consider when deciding whether to extend or reinstitute the fee bump in the coming years.

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The Limits of Marginal Economic Incentives in the Medicaid Program: Concerns and Cautions

Cited by 16 publications

References 11 publications

Effects of Community Factors on Access to Ambulatory Care for Lower-Income Adults in Large Urban Communities

Effects of Community Factors on Access to Ambulatory Care for Lower-Income Adults in Large Urban Communities

Expanding Medicaid Access without Expanding Medicaid: Why Did Some Nonexpansion States Continue the Primary Care Fee Bump?

To Extend or Not to Extend the Primary Care “Fee Bump” In Medicaid?

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