Friday, January 23, 2009

medicaid, physician payment , doctor shortage, access - Medicaid-For-All and Physicians

I could not help but notice the NEJM is pushing its agenda for national health insurance in a new and creative way. In its January 22 edition, in its perspective section, its published “Health Care 2009: Medicaid and the Path to National Health Insurance.” Its author is Dr. Michael Sparer, a PhD and Professor of Health Policy at the Columbia University’s Mailman School of Public Health.

In his article, Dr. Sparer has this paragraph,

More difficult would be convincing physicians to support a Medicaid expansion and participate in the program. Although Medicaid participation is high in some states, it is more typical for office-based physicians to refuse to treat Medicaid patients, citing low reimbursement rates and long administrative delays. Medicaid agencies (or the managed-care plans they rely on) will need to pay higher rates, though increases that are substantial enough to attract physician participation would undermine cost-containment efforts. Medicaid agencies could also rely more heavily on nurse practitioners and physician assistants, but any effort to simply bypass the physician community will fail. Here again, however, the laboratory of federalism could help, since there are states that effectively partner with office-based physicians and have lessons to share.

As I read this paragraph, I could help but wonder, where does Dr. Sparer now go when he gets sick – to his favorite Medicaid physician extender, to the local Medicaid physician, or to a specialist at Columbia?

I expect he finds practitioners or their extenders accepting Medicaid hard if not impossible to find, so he will have to turn to the Columbia specialists.

Perhaps his situation will change in the future. Perhaps government can overcome the fact that many private doctors do not accept Medicaid because of low pay, bureaucratic obstacles, and long waits for reimbursement. Perhaps government can overcome the stigma attached to the name “Medicaid.” But these are Big Perhaps.

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