Lee D W, Gillis K D
Center for Health Policy Research, American Medical Association, Chicago, IL 60610.
Inquiry. 1993 Winter;30(4):417-28.
This paper examines the impact of Medicare physician payment reform on access to care by comparing several physician-based access measures in the pre- and post-reform periods. The results suggest that the broad goals of payment reform may have been at least partially achieved: the proportion of physician revenues derived from Medicare increased for primary care physicians and decreased for nonprimary care MDs; there was little change in the absolute or relative number of visits provided to Medicare patients; and an increasing number of physicians charged no more than the Medicare payment amount. Some signs of deteriorating access were found, however. Fewer physicians were willing to treat all new Medicare patients and more physicians accepted no new Medicare patients. Furthermore, there was an increase in the proportion of physicians who reduced or stopped providing to Medicare patients certain types of services that they continued to provide to other patients.
本文通过比较改革前后基于医生的多项医疗可及性指标，研究了医疗保险医生支付改革对医疗可及性的影响。结果表明，支付改革的总体目标可能至少部分得以实现：初级保健医生来自医疗保险的收入比例有所增加，而非初级保健医生的这一比例则有所下降；为医疗保险患者提供诊疗的绝对数量或相对数量变化不大；越来越多的医生收取的费用不超过医疗保险支付金额。然而，也发现了一些医疗可及性恶化的迹象。愿意诊治所有新医疗保险患者的医生减少，更多医生不接受新的医疗保险患者。此外，减少或停止为医疗保险患者提供某些他们仍继续为其他患者提供的服务的医生比例有所上升。
