Doctors are likely to accept new Medicaid patients as coverage expands, but they may not accept patients who remain uninsured, according to a study from Virginia Commonwealth University, Richmond.
Researchers analyzed data from a long-term, nationwide study of changes in the healthcare system: the Community Tracking Study Physician Survey. Physician survey responses from the mid-1990s to the mid-2000s were tracked to assess how market-level changes in Medicaid coverage affected doctors’ acceptance of new patients, including patients covered by Medicaid and uninsured patients who were unable to pay.
For most of the period studied, Medicaid coverage rates increased while uninsurance rates trended lower. Both rates varied between different markets. About 70 percent of physicians surveyed were in solo or group medical practice.
Key findings from the study included the following:
- Changes in Medicaid coverage did not significantly affect doctors’ acceptance of new Medicaid patients.
- About 72 percent of office-based physicians, and 90 percent of facility-based doctors, accepted new Medicaid patients, rates that remained about the same after changes in Medicaid coverage.
- When Medicaid coverage rates increased, physicians became less likely to accept new uninsured patients. For each one percentage point increase in Medicaid coverage, there was a one-half point decrease in the likelihood that doctors would accept new uninsured patients.
- Office-based physicians were more likely to stop accepting new uninsured patients in response to changes in Medicaid coverage.
- Charity care was unaffected by changes in Medicaid coverage, but increased in markets where more people became uninsured.
While Medicaid expansion will reduce the number of people who are uninsured, coverage does not guarantee access, the researchers note. Practice decisions made by doctors in response to financial incentives will affect access to care for newly insured patients. Estimates suggest that a substantial number of people will remain uninsured despite Medicaid expansion, and some states do not plan to expand Medicaid coverage.
Additional support or incentives may be needed to ensure access to care for people who are still uninsured after Medicaid expansion, researchers add.
Source: Wolters Kluwer Health, October 16, 2013
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