Barrilleaux C J, Miller M E
Florida State University.
J Health Polit Policy Law. 1992 Spring;17(1):97-118. doi: 10.1215/03616878-17-1-97.
States have implemented a number of strategies to provide services, pay providers, and control Medicaid spending. We test the effects of some differences in state Medicaid policies on program enrollees' access to and use of health care services. Logistic and OLS regression analyses of cross-sectional data indicate that these policies exert significant influences on enrollees' access to health services but have a weaker direct effect on their use of them. However, we find evidence that utilization is affected indirectly (through increased access) by state policy decisions. Somewhat surprisingly, Medicaid policies designed to contain costs by limiting utilization appear to affect neither access nor utilization. Medicaid enrollees have greater access to a private physician in states with higher physician reimbursement and additional Medicare insurance for their enrollees. Other nonpolicy variables with pronounced impacts on access to private office physicians include race and the availability of private insurance.
各州已实施了一系列策略来提供服务、支付医疗服务提供者费用并控制医疗补助支出。我们测试了各州医疗补助政策的一些差异对该项目参保者获得和使用医疗服务的影响。对横截面数据进行的逻辑回归和普通最小二乘法回归分析表明，这些政策对参保者获得医疗服务有重大影响，但对他们使用医疗服务的直接影响较弱。然而，我们发现有证据表明，州政策决策会间接影响（通过增加获得机会）医疗服务的使用。有点令人惊讶的是，旨在通过限制使用来控制成本的医疗补助政策似乎对获得机会和使用情况均无影响。在医生报销率较高且为参保者提供额外医疗保险的州，医疗补助参保者更容易获得私人医生的服务。其他对获得私人诊所医生服务有显著影响的非政策变量包括种族和私人保险的可获得性。
