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Not Even Higher Payments Can Help Medicaid

It’s widely known that while there is some variation, in most states Medicaid reimburses physicians at significantly lower rates than private insurers. As we’ve previously highlighted, research indicates that these low rates of payment affect physicians’ decisions to treat Medicaid patients.

While low reimbursement is a serious problem in Medicaid that ultimately compromises access and thus quality of care for those receiving public assistance, a new study published yesterday by Health Affairs finds that administrative burdens—in particular payment delays— can also have a significant effect on physicians decisions to accept Medicaid patients.

In the words of Health System Change Senior Fellow Peter Cunningham (coauthor of the study with Ann O’Malley), here’s the key take-away:

Medicaid payment rates matter, but the hassle factor also matters, and this study strongly suggests that higher Medicaid fees won’t have the desired effect of increasing access if physicians have to wait months to get paid.

  • Author: Greg D'Angelo
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6 Comments

November 19, 2008 Roger L. Cooper, Vero Beach, Fl writes:

As a elderly beneficiary of medicare with a large number of serious illneses and injuries,I have yet to observe physicians who are suffering from severe financial difficulties that can be attributed to Medicare.

November 19, 2008 Robert Meyer, San Antonio, TX writes:

I know a guy who has put together a business plan for a business specializing in just processing Medicare paperwork. Please educate me. Don’t we already have universal health coverage through Medicare and Medicaid? If these programs set a pricing scale, what is the motivation for a doctor to be “the best”?

November 19, 2008 Barb -mn writes:

All states and local government agencies subsidizing health care should be removed. All monies from each government healthcare program, agency, etc can be put into medicare and medicaid. Whatever is for the born and raised elderly of this country.

Allow the market to open insurance companies so those living in luxury, complaining about not having healthcare can realize and take on their priorities (responsibilities)at their expense. The elderly should not have out of pocket expenses while others get it for free.

It is the people that pay their way that do not receive good health care, where short cuts are put on them. Why? Because those that pay, are more apt to let poor care go as they are less the time and money to fight it. But those that get it free, also get free lawyers who in more cases then not, win the case whether legitimate or not.

November 20, 2008 Debra Lee, Pittsburgh writes:

Wow, the above 3 comments just don’t make sense to me whatsoever; however, I have been on the billing side of Medicare and Medicaid for several years. I can vouch that doctors do not like taking Medicaid as their reimbursement fees are below sea level, but they do make money - by doing volume. Thus, less quality care, but the patient does get care. It may not necessarily be substandard, but the doctor/provider will spend less time with a Medicaid patient because of the low fee. The paperwork requirement for Medicare and Medicaid is what is also making it next to impossible to deal with the government-sponsored programs, especially Waivers. I like the idea of the government paying the premiums for private insurance for citizens who cannot afford to pay, thus their “Medicaid” will be invisible to the provider and they get the care they need (there would have to be some kind of cap on the benefits as, through experience, beneficiaries will abuse their privileges/benefits).

November 20, 2008 Dell in South Carolina writes:

We have a disabled granddaughter who’s had a horrendous rash for four years. She’s on Medicaid and seriously diabetic. For all this time, no doctor–dermatologist, immunologist, allergist, no one!–could or would help her and they only rarely tried to diagnose her condition. I went on WebMD and found that one of the side effects of diabetes is what they call “nerve pain”. I told her; she told her primary care physician; they prescribed an inexpensive medication for her and she’s now almost completely clear of the rash. This young lady would wake up bleeding in the middle of the night from scratching! She had to drop out of college and almost stopped going out in public because of the scarring she’s suffered.

I don’t know whom to be angry at–the doctors who didn’t seem to care or the government-funded system who pushed her off into a corner and watched her suffer. Either way, I’m angry and don’t know what to do about it other than sit here and boil! Where does one go to get some kind of compassionate response in a situation like this? All those doctors got their money even if it DID take a while–it obviously didn’t take FOUR YEARS!

Just sign me “Frustrated”!!!

November 20, 2008 Dinah, Orlando writes:

Dell in SC - Welcome to Socialized Health Care. It will only get worse from here once Obama takes over. Why do you think the citizens living in countries with socialized health care come to the U.S? It’s because as bad as it is, it’s better than Government run Socialized Health care.

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