State Medicaid Fees and Access to Primary Care Physicians

Authors

Rajiv Sharma, Portland State UniversityFollow
Sarah E. Tinkler, Portland State UniversityFollow
Arnab Mitra, Portland State UniversityFollow
Sudeshna Pal, Portland State UniversityFollow
Raven Susu-Mago, Portland State University

Sponsor

Portland State University, Grants/Awards:College of Liberal Arts and Sciences, Faculty Enhancement Committee, Institute for Sustainable Solutions and Office of Research and Strategic Partnerships.

Published In

Health Economics

Document Type

Post-Print

Publication Date

3-1-2018

Subjects

Medical economics, Health care issues -- Costs and access

Abstract

Medicaid and uninsured patients are disadvantaged in access to care and are disproportionately Black and Hispanic. Using a national audit of primary care physicians, we examine the relationship between state Medicaid fees for primary care services and access for Medicaid, Medicare, uninsured, and privately insured patients who differ by race/ethnicity and sex. We found that states with higher Medicaid fees had higher probabilities of appointment offers and shorter wait times for Medicaid patients, and lower probabilities of appointment offers and longer wait times for uninsured patients. Appointment offers and wait times for Medicare and privately insured patients were unaffected by Medicaid fees. At mean state Medicaid fees, our analysis predicts a 27‐percentage‐point disadvantage for Medicaid versus Medicare in appointment offers. This decreases to 6 percentage points when Medicaid and Medicare fees are equal, suggesting that permanent fee parity with Medicare could eliminate most of the disparity in appointment offers for Medicaid patients. The predicted decrease in the disparity is smaller for Black and Hispanic patients than for White patients. Our research highlights the importance of considering the effects of policy on nontarget patient groups, and the consequences of seemingly race‐neutral policies on racial/ethnic and sex‐based disparities.

Description

This is the peer reviewed version of the article: which has been published in final form at http://dx.doi.org/10.1002/hec.3591

This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.

DOI

10.1002/hec.3591

Persistent Identifier

https://archives.pdx.edu/ds/psu/25941

Citation Details

Sharma R, Tinkler S, Mitra A, Pal S, Susu-Mago R, Stano M. State Medicaid fees and access to primary care physicians. Health Econ omics. 2018;27:629-636.