Perloff J D, Kletke P R, Neckerman K M
Med Care. 1986 Aug;24(8):749-60. doi: 10.1097/00005650-198608000-00010.
Many Medicaid policy changes occurred in recent years including those resulting from the Omnibus Budget Reconciliation Act of 1981 and the Tax Equity and Fiscal Responsibility Act of 1982. At the same time, the supply of providers increased and the health care market became more competitive. This paper presents evidence about how these developments are affecting pediatricians' participation in state Medicaid programs. Surveys conducted in 1978 (N = 814) and 1983 (N = 791) indicate that the proportion participating declined only slightly from 85.1% to 82.0%. The average Medicaid case load of participants remained at 15%, although extent of participation of individual pediatricians fluctuated. Previous research demonstrates that physicians' Medicaid participation is affected by reimbursement level, administrative complexity, and generosity of eligibility and benefits. Our data confirm these influences. However, the longitudinal design of the analyses reported here also captures shifts in the relative influence of these factors. The influence of policy factors has diminished over time, while the influence of changes in physician supply has increased. Increased physician supply, however, is associated with decreased Medicaid participation. Thus, diminished access to pediatric care for low-income children may result from recent changes in Medicaid and in the broader health care environment.
近年来发生了许多医疗补助政策变化，包括1981年《综合预算调节法案》和1982年《税收公平与财政责任法案》带来的政策变化。与此同时，医疗服务提供者的数量增加，医疗保健市场竞争更加激烈。本文展示了这些发展变化如何影响儿科医生参与州医疗补助计划的相关证据。1978年（N = 814）和1983年（N = 791）进行的调查表明，参与计划的比例仅从85.1%略微下降至82.0%。参与者的平均医疗补助病例负担保持在15%，尽管个别儿科医生的参与程度有所波动。先前的研究表明，医生参与医疗补助计划受到报销水平、行政复杂性以及资格和福利的慷慨程度的影响。我们的数据证实了这些影响。然而，本文所报告分析的纵向设计也捕捉到了这些因素相对影响力的变化。随着时间的推移，政策因素的影响力减弱，而医生供给变化的影响力增强。然而，医生供给增加与医疗补助参与率下降相关。因此，低收入儿童获得儿科护理的机会减少可能是近期医疗补助计划变化以及更广泛的医疗保健环境变化所致。
