Perloff J D, Kletke P R, Fossett J W, Banks S
School of Social Welfare, SUNY, Albany, NY 12222, USA.
Med Care. 1997 Feb;35(2):142-57. doi: 10.1097/00005650-199702000-00005.
This article describes Medicaid participation among office-based primary care physicians in cities and examines its determinants.
Data used in this study were collected through the 1993 and 1994 American Medical Association Socioeconomic Monitoring System telephone surveys. The sample includes 1,300 primary care physicians. Our multivariate model includes a variety of personal, practice, community, and policy factors thought to influence participation. Logistic regression was used to examine determinants of accepting any Medicaid patients and ordinary least square regression was used to examine determinants of the extent of participation among participants.
The authors found that 19% of respondents did not participate in Medicaid and 62% had practices with 9% or fewer Medicaid patients. Multivariate analyses indicated that Medicaid payment levels were not associated with observed patterns of Medicaid participation. Community sociodemographic characteristics and demand from Medicaid-eligibles, by contrast, play a significant role in influencing observed levels of participation.
Strategies other than raising Medicaid payment levels will be needed to achieve equitable access to office-based primary care for the poor residing in cities.
本文描述了城市中以诊所为基础的初级保健医生参与医疗补助计划的情况，并对其影响因素进行了研究。
本研究使用的数据是通过1993年和1994年美国医学协会社会经济监测系统电话调查收集的。样本包括1300名初级保健医生。我们的多变量模型包括各种被认为会影响参与情况的个人、执业、社区和政策因素。采用逻辑回归分析接受任何医疗补助计划患者的影响因素，采用普通最小二乘法回归分析参与者参与程度的影响因素。
作者发现，19%的受访者未参与医疗补助计划，62%的受访者的诊所中医疗补助计划患者占比为9%或更低。多变量分析表明，医疗补助计划的支付水平与观察到的参与模式无关。相比之下，社区社会人口特征和符合医疗补助计划资格者的需求在影响观察到的参与水平方面发挥着重要作用。
要实现城市贫困人口公平获得以诊所为基础的初级保健服务，需要采取提高医疗补助计划支付水平以外的策略。
