Perloff J D, Kletke P R, Neckerman K M
J Health Polit Policy Law. 1987 Summer;12(2):221-35. doi: 10.1215/03616878-12-2-221.
Although most primary care physicians participate in state Medicaid programs, they may accept all Medicaid patients, or they may choose to limit their participation. This decision allows physicians to adjust their Medicaid caseloads to a desired level, and it has important implications for the access of low-income patients to health care. Surveys of pediatricians in 1978 and 1983 indicate that the proportion of pediatricians limiting their Medicaid participation increased significantly from 26 percent to 35 percent (p less than .001). In addition, in both 1978 and 1983, limited participants saw significantly fewer Medicaid patients than full participants. This paper describes a number of strategies available to federal and state policymakers for fostering full Medicaid participation. Multivariate analyses indicate that increasing reimbursement levels is an important strategy for encouraging full Medicaid participation. In addition, full participants will increase their Medicaid caseloads in response to a variety of Medicaid policy incentives, while limited participants are found to respond to fewer policy incentives. The authors conclude that caution will be needed to ensure that health care cost-containment strategies such as capitation or selective contracting do not inadvertently discourage participation among both full and limited Medicaid participants.
尽管大多数初级保健医生参与了州医疗补助计划，但他们可以接纳所有医疗补助患者，也可以选择限制自己的参与程度。这一决定使医生能够将其医疗补助工作量调整到理想水平，并且对低收入患者获得医疗保健服务有着重要影响。1978年和1983年对儿科医生的调查表明，限制参与医疗补助计划的儿科医生比例从26%显著增至35%（p小于0.001）。此外，在1978年和1983年，限制参与的医生接诊的医疗补助患者明显少于完全参与的医生。本文介绍了联邦和州政策制定者可用来促进全面参与医疗补助计划的一些策略。多变量分析表明，提高报销水平是鼓励全面参与医疗补助计划的一项重要策略。此外，完全参与的医生会因各种医疗补助政策激励措施而增加其医疗补助工作量，而限制参与的医生对政策激励措施的反应较少。作者得出结论，需要谨慎确保诸如按人头付费或选择性签约等医疗保健成本控制策略不会无意中阻碍完全参与和有限参与的医疗补助参与者的参与。
