Adams E K
Emory University School of Public Health, Atlanta, GA 30329.
Inquiry. 1994 Summer;31(2):173-87.
Integration of low-income persons, now covered largely through Medicaid, into mainstream provider networks requires sufficient numbers of physicians willing to serve them. This paper examines a 1986 change in fees in Tennessee that was aimed explicitly at increasing physician participation in Medicaid. County/monthly panel data from 1985-1988 were used to examine visits per enrollee, physician participation, and caseloads. Higher fees were found to lead to increased participation in both urban and rural countries, but were less effective in increasing the number of visits per enrollee in urban areas and physician caseloads in both urban and rural areas. A measure of the residential segregation of Medicaid enrollees within each county was found to have a negative influence on the number of visits per enrollee, on participation, and on caseloads when measured across all participating physicians.
目前主要通过医疗补助计划覆盖的低收入人群融入主流医疗服务网络，需要有足够数量愿意为他们服务的医生。本文研究了1986年田纳西州的一项费用调整，该调整明确旨在提高医生参与医疗补助计划的积极性。利用1985年至1988年的县/月度面板数据来研究每名参保人的就诊次数、医生参与情况和工作量。研究发现，提高费用会导致城市和农村地区的参与率均有所提高，但在增加城市地区每名参保人的就诊次数以及城市和农村地区医生工作量方面效果较差。研究发现，如果衡量每个县内医疗补助计划参保人的居住隔离情况，那么在衡量所有参与医生时会发现，这对每名参保人的就诊次数、参与率和工作量都有负面影响。
