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The Effects of Medicaid Reimbursement on the Access to Care of Medicaid Enrollees: A Community Perspective

Center for Studying Health System Change

Len M. Nichols

New America Foundation

Previous research has not found a strong association between Medicaid reimbursement levels and enrollees’ access to medical care, even though higher fees increase the acceptance of Medicaid patients by physicians. This study shows that high Medicaid acceptance rates by physicians in a community are more important than fee levels per se in affecting enrollees’ access to medical care. Although high fee levels increase the probability that individual physicians will accept Medicaid patients, high fee levels do not necessarily lead to high levels of physician Medicaid acceptance in an area. Numerous other physician practice, health system, and community characteristics also affect Medicaid acceptance. The effects of Medicaid fees on Medicaid acceptance are substantially lower in areas with high Medicaid managed care penetration and for physicians who practice in institutional settings. The results suggest that a broad range of factors need to be considered to increase access to physicians for Medicaid enrollees.

Key Words: Medicaid • reimbursement • access • physician acceptance

Medical Care Research and Review, Vol. 62, No. 6, 676-696 (2005)
DOI: 10.1177/1077558705281061


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