Abstract
The roles of reimbursement and other predictors that affect physicians’ willingness to accept publicly insured continuing care patients were examined in a national survey. The response rate was 47%. Eighty-eight percent of the respondents were accepting new patients. Forty-two percent of these physicians were willing to accept new continuing care patients insured by Medicaid, 70% reported accepting those paying by Medicare assignment, and 85% said they accept patients covered by Medicare plus balance-billing payments. Low reimbursement was the strongest predictor for lack of acceptance. The results suggest that systems of multitiered reimbursement are associated with diminished access for patients insured in the lower tiers.
This is a preview of subscription content, log in via an institution to check access.
References
Weissman JS, Stern R, Fielding SL, Epstein AM. Delayed access to health care: risk factors, reasons, and consequences. Ann Intern Med. 1991;114:325–31.
Spillman BC. The impact of being uninsured on utilization of basic health care services. Inquiry. 1992;29:457–66.
Hadley J, Steinberg EP, Feder J. Comparison of uninsured and privately insured hospital patients: condition on admission, resource use. and outcome. JAMA. 1991;265:374–9.
Freeman HE, Aiken LH, Blendon RJ, Corey CR. Uninsured working-age adults: characteristics and consequences. Health Serv Res. 1990;24:811–23.
Fihn SD. Wicher JB. Withdrawing routine outpatient medical services: effects on access and health. J Gen Intern Med. 1988;3: 356–62.
Franks P, Clancy CM, Gold MR. Health insurance and mortality, evidence from a national cohort. JAMA. 1993;270:737–41.
Burstin HR, Lipsitz SR, Brennan TA. Socioeconomic status and risk for substandard medical care. JAMA. 1992;268:2383–7.
Himmelstein DU, Woolhandler S. The National Health Program Chartbook. Cambridge, MA: Center for National Health Program Studies, 1992:4.
Kelly C, Gemeinhardt E. Public attitudes on health care reform. Statist Bull. 1992;73(4):2–10.
Brown LD. Policy reform as creative destruction: political and administrative challenges in preserving the public—private mix. Inquiry. 1992;29:188–202.
Mitchell JB. Physician participation in Medicaid revisited. Med Care. 1991;29:645–53.
Perloff JD, Kletke PR, Neckerman KM. Physicians’ decisions to limit Medicaid participation: determinants and policy implications. J Health Polit Policy Law. 1987;12:221–35.
Newacheck PW. Access to ambulatory care for poor persons. Health Serv Res. 1988;23:401–19.
Kleinman JC, Gold M, Makuc D. Use of ambulatory medical care by the poor: another look at equity. Med Care. 1981:XIX:1011–29.
Anonymous. Monitoring access to Medicare. Physician Marketplace Update. 1991;2(3):1–2.
Moy E, Hogan C. Access to needed follow-up services: variations among different Medicare populations. Arch Intern Med. 1993;153:1815–23.
Gillis KD, Lee DW, Willke RJ. Physician-based measures of Medicare access. Inquiry. 1992;29:321–31.
Hayward RA, Shapiro MF, Freeman HE, Corey CR. Inequities in health services among insured Americans: do working-age adults have less access to medical care than the elderly? N Engl J Med. 1988;318:1507–12.
The Medicaid Access Study Group. Access of Medicaid recipients to outpatient care. N Engl J Med. 1994;330:1426–30.
Cykert S, Layson RT. Will universal health insurance assure universal access to ongoing primary care for adults? Arch Fam Med. 1993;2:1153–5.
Author information
Authors and Affiliations
Additional information
Received from the Internal Medicine Training Program and the Area Health Education Center of The Moses H. Cone Memorial Hospital, Greensboro, the Department of Internal Medicine, University of North Carolina School of Medicine, Chapel Hill, and the Department of Mathematics, University of North Carolina at Greensboro, Greensboro, North Carolina.
Supported by the Education Committee of The Moses H. Cone Memorial Hospital, Greensboro, North Carolina.
Rights and permissions
About this article
Cite this article
Cykert, S., Kissling, G., Layson, R. et al. Health insurance does not guarantee access to primary care. J Gen Intern Med 10, 345–348 (1995). https://doi.org/10.1007/BF02599955
Issue Date:
DOI: https://doi.org/10.1007/BF02599955