Cykert S, Layson R T
Internal Medicine Teaching Program, Moses H. Cone Memorial Hospital, Greensboro, NC.
Arch Fam Med. 1993 Nov;2(11):1153-5. doi: 10.1001/archfami.2.11.1153.
To assess the impact of current public insurance status (Medicare and Medicaid) and hypothetical payment levels of a new insurance program on physician acceptance of adult primary care patients desiring continuing care.
Survey of 175 primary care physicians in a medium-sized city and six surrounding counties in North Carolina.
Likelihood of accepting new continuing care patients covered by Medicare, Medicaid, or a hypothetical health insurance system mandated to cover the uninsured.
The response rate was 80%; 86% of the respondents were accepting new patients with private insurance. Of the remaining physicians, 72% were not accepting new continuing care patients covered by Medicaid and 55% were not accepting patients who paid via Medicare assignment alone. Seventy-nine percent of respondents were unlikely to accept new continuing care patients insured by a hypothetical public plan that reimbursed physicians at 60% of reimbursement levels provided by privately insured patients, compared with only 25% who were unlikely to accept patients if the reimbursement was 80% of the private level.
Medicaid and Medicare do not assure access to continuing primary care. Also, physician reimbursement is an important determinant in any new health care system designed to provide universal and consistent access to regular primary care services.
评估当前公共保险状况（医疗保险和医疗补助）以及一项新保险计划的假设支付水平对医生接纳希望接受持续治疗的成年初级保健患者的影响。
对北卡罗来纳州一个中等规模城市及周边六个县的175名初级保健医生进行调查。
接纳由医疗保险、医疗补助或一项强制覆盖未参保者的假设性医疗保险体系承保的新持续治疗患者的可能性。
回复率为80%；86%的受访者接纳有私人保险的新患者。在其余医生中，72%不接纳由医疗补助承保的新持续治疗患者，55%不接纳仅通过医疗保险代付方式付费的患者。79%的受访者不太可能接纳由一项假设性公共计划承保的新持续治疗患者，该计划向医生的报销水平为私人参保患者报销水平的60%，相比之下，如果报销水平为私人水平的80%，则只有25%的受访者不太可能接纳患者。
医疗补助和医疗保险并不能确保获得持续的初级保健服务。此外，在任何旨在提供普遍且一致的常规初级保健服务的新医疗体系中，医生报销都是一个重要的决定因素。
