American Academy of Pediatrics, Elk Grove Village, Illinois;
Department of Pediatrics, College of Medicine, University of Florida, Jacksonville, Florida.
Pediatrics. 2018 Jan;141(1). doi: 10.1542/peds.2017-2570.
Whether the Medicaid primary care payment increase of 2013 to 2014 changed physician participation remains unanswered amid conflicting evidence. In this study, we assess national and state-level changes in Medicaid participation by office-based primary care pediatricians before and after the payment increase.
Using bivariate statistical analysis, we compared survey data collected from 2011 to 2012 and 2015 to 2016 by the American Academy of Pediatrics from state-stratified random samples of pediatrician members.
By 4 of 5 indicators, Medicaid participation increased nationally from 2011 and 2012 to 2015 and 2016 ( = 10 395). Those accepting at least some new patients insured by Medicaid increased 3.0 percentage points (ppts) to 77.4%. Those accepting all new patients insured by Medicaid increased 5.9 ppts to 43.3%, and those accepting these patients at least as often as new privately insured patients increased 5.7 ppts to 55.6%. The average percent of patients insured by Medicaid per provider panel increased 6.0 ppts to 31.3%. Nonparticipants dropped 2.1 ppts to 14.6%. Of the 27 studied states, 16 gained in participation by 1 or more indicators, 11 gained by 2 or more, and 3 gained by all 5.
Office-based primary care pediatricians increased their Medicaid participation after the payment increase, in large part by expanding their Medicaid panel percentage. Continued monitoring of physician participation in Medicaid at the national and state levels is vital for guiding policy to optimize timely access to appropriate health care for >37 million children insured by Medicaid.
2013 年至 2014 年，医疗补助（Medicaid）初级保健支付增加，这是否改变了医生的参与情况，目前仍缺乏明确的证据。在这项研究中，我们评估了支付增加前后，以办公室为基础的初级保健儿科医生在全国和州一级的 Medicaid 参与情况的变化。
我们使用双变量统计分析，比较了美国儿科学会（AAP）在 2011 年至 2012 年和 2015 年至 2016 年期间，从儿科医生成员的州分层随机样本中收集的调查数据。
通过 5 个指标中的 4 个，从 2011 年和 2012 年到 2015 年和 2016 年，全国范围内 Medicaid 的参与度增加（n=10395）。接受至少部分新的 Medicaid 保险患者的医生比例增加了 3.0 个百分点（ppts），达到 77.4%。接受所有新的 Medicaid 保险患者的医生比例增加了 5.9 ppts，达到 43.3%，而接受这些患者的频率与新的私人保险患者相同或更高的医生比例增加了 5.7 ppts，达到 55.6%。每位医生的 Medicaid 保险患者的平均比例增加了 6.0 ppts，达到 31.3%。非参与者下降了 2.1 ppts，至 14.6%。在研究的 27 个州中，有 16 个州在 1 个或多个指标上有所增加，11 个州在 2 个或更多指标上有所增加，3 个州在所有 5 个指标上都有所增加。
在支付增加后，以办公室为基础的初级保健儿科医生增加了 Medicaid 的参与度，在很大程度上是通过扩大 Medicaid 患者的比例。继续在国家和州一级监测医生参与 Medicaid 的情况，对于指导政策以优化 3700 多万 Medicaid 保险儿童及时获得适当医疗保健至关重要。
