Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, MA, USA.
Department of Public Health Sciences, The University of Chicago, Chicago, IL, USA.
J Gen Intern Med. 2019 Oct;34(10):2200-2209. doi: 10.1007/s11606-019-05160-x. Epub 2019 Aug 6.
Changing Medicaid fees is a common approach for states to address budget fluctuations, and many currently set Medicaid physician fees at levels lower than Medicare and private insurers. The Affordable Care Act included a temporary Medicaid fee bump for primary care providers (PCPs) in 2013-2014 that recently led to both an increase and then subsequent decrease in PCP fees in many states.
To conduct a systematic literature review on the effects of changing Medicaid fees on provider participation and enrollees' access to care and service use.
We searched PubMed/Medline and JSTOR and identified 18 studies that assessed the longitudinal impact of provider fee changes in Medicaid on the outcomes of interest. We summarized information on study design, methods, and findings.
Seven studies examined the impact of fee changes on provider participation in Medicaid. Of these, three studies found that fee increases were associated with positive effects on providers' likelihood of accepting Medicaid patients or on their Medicaid caseloads. Five studies that examined the impact of fee changes on Medicaid enrollees' access to care found a positive association with one or more access measure, such as having a usual source of care or appointment availability. Lastly, eight of 14 studies that examined service use found positive associations between fee changes and at least one measure of use, such as changes in the probability of enrollees having any visit, the number of visits, and shifts in the site of care toward office-based care; others largely did not find significant associations.
There is mixed evidence on the impact of changing Medicaid fees on provider participation and enrollees' service use; however, increasing fees appears to have more consistent positive effects on access to care. Whether these improvements in access translate into better health outcomes or downstream cost savings are critical questions.
改变医疗补助（Medicaid）费用是各州解决预算波动的常用方法，许多州目前将医疗补助医生的费用设定在低于医疗保险（Medicare）和私人保险公司的水平。平价医疗法案（Affordable Care Act）在 2013-2014 年为初级保健提供者（PCP）提供了一项临时医疗补助费用提升，这导致许多州的 PCP 费用近期既有所增加，随后又有所下降。
对改变医疗补助费用对提供者参与以及参保者获得医疗服务和使用服务的影响进行系统文献回顾。
我们在 PubMed/Medline 和 JSTOR 上进行了搜索，确定了 18 项评估医疗补助提供者费用变化对相关结果的纵向影响的研究。我们总结了研究设计、方法和发现的信息。
有 7 项研究考察了费用变化对医疗补助提供者参与的影响。其中，有 3 项研究发现，费用增加与提供者接受医疗补助患者或增加其医疗补助患者人数的可能性呈正相关。有 5 项研究考察了费用变化对医疗补助参保者获得医疗服务的影响，发现与一个或多个获得性措施呈正相关，例如有常规医疗来源或预约可用性。最后，在 14 项研究中有 8 项研究发现，费用变化与至少一项使用措施之间存在正相关，例如参保者任何就诊、就诊次数的变化以及医疗服务从非办公室医疗向办公室医疗的转变；其他研究则大多未发现显著关联。
改变医疗补助费用对提供者参与和参保者服务使用的影响存在混合证据；然而，提高费用似乎对获得医疗服务有更一致的积极影响。这些获得性改善是否转化为更好的健康结果或下游成本节约是至关重要的问题。
