Cornell University, Ithaca, NY, USA.
William & Mary, Williamsburg, VA, USA.
Med Care Res Rev. 2020 Feb;77(1):85-95. doi: 10.1177/1077558718772165. Epub 2018 Apr 30.
Physician acceptance is an important dimension of access to care, especially for Medicaid patients. We constructed two new measures to quantify primary care physician (PCP) acceptance of Medicaid patients using geocoded Virginia physician addresses and population data and geospatial methods. For each Census block group, we measured the shares of "accessible PCPs" accepting any Medicaid patients or new Medicaid patients. Accessible PCPs were defined as those located within 30-minute travel from patient locations and patient locations were proxied by Census block group geographic centroids. We found that the shares of accessible PCPs accepting Medicaid varied within Virginia, and were significantly lower in urban communities where larger fractions of the population were Hispanic, even controlling for unobserved market-level traits associated with Medicaid acceptance. Policy makers and Medicaid program officials should continue to improve nonfinancial access to primary care, especially by addressing access barriers in communities with high shares of minority residents.
医生的认可对于医疗服务的可及性来说是一个重要的维度，尤其是对于医疗补助计划（Medicaid）的患者来说。我们使用地理编码的弗吉尼亚州医生地址和人口数据以及地理空间方法构建了两个新的措施来量化初级保健医生（PCP）对医疗补助计划患者的接受程度。对于每个人口普查块组，我们衡量了接受任何医疗补助计划患者或新医疗补助计划患者的“可及 PCP”的份额。可及的 PCP 是指那些位于从患者所在地 30 分钟车程内的医生，而患者所在地则由人口普查块组地理中心点代理。我们发现，弗吉尼亚州内可接受医疗补助计划的 PCP 的份额存在差异，在人口中西班牙裔比例较高的城市社区中，这一比例明显较低，即使控制了与接受医疗补助计划相关的未观察到的市场特征。政策制定者和医疗补助计划官员应继续改善初级保健的非财务可及性，特别是要解决少数民族居民比例较高的社区中的准入障碍。
