Brunt Christopher S, Jensen Gail A
Department of Finance and Economics, Georgia Southern University, Statesboro, GA , 30460, USA,
Int J Health Care Finance Econ. 2014 Dec;14(4):289-310. doi: 10.1007/s10754-014-9152-y. Epub 2014 Jul 9.
Using 2008 physician survey data, we estimate the relationship between the generosity of fees paid to primary care physicians under Medicaid and Medicare and his/her willingness to accept new patients covered by Medicaid, Medicare, or both programs (i.e., dually enrolled patients). Findings reveal physicians are highly responsive to fee generosity under both programs. Also, their willingness to accept patients under either program is affected by the generosity of fees under the other program, i.e., there are significant spillover effects between Medicare and Medicare fee generosity. We also simulate how physicians in 2008 would have likely responded to Medicaid and Medicare payment reforms similar to those embodied in the 2010 Affordable Care Act, had they been permanently in place in 2008. Our findings suggest that "Medicaid Parity" for primary care physicians would have likely dramatically improved physician willingness to accept new Medicaid patients while only slightly reducing their willingness to accept new Medicare patients. Also, many more primary care physicians would have been willing to treat dually enrolled patients.
利用2008年医生调查数据，我们估算了医疗补助计划（Medicaid）和老年医保计划（Medicare）支付给初级保健医生的费用的慷慨程度与医生接受医疗补助计划、老年医保计划或两个计划都覆盖的新患者（即双重参保患者）的意愿之间的关系。研究结果显示，在这两个计划下，医生对费用慷慨程度的反应都很强烈。此外，他们接受任一计划患者的意愿会受到另一计划费用慷慨程度的影响，也就是说，老年医保计划和医疗补助计划的费用慷慨程度之间存在显著的溢出效应。我们还模拟了如果2010年《平价医疗法案》中的类似医疗补助计划和老年医保计划支付改革在2008年就已永久实施，2008年的医生可能会有怎样的反应。我们的研究结果表明，初级保健医生的“医疗补助计划平价”可能会极大地提高医生接受新医疗补助患者的意愿，同时只会略微降低他们接受新老年医保患者的意愿。此外，会有更多的初级保健医生愿意治疗双重参保患者。
