Physician willingness and resources to serve more Medicaid patients: perspectives from primary care physicians.

OBJECTIVE: Sixteen million people will gain Medicaid under health reform. This study compares primary care physicians (PCPs) on reported acceptance of new Medicaid patients and practice characteristics. DATA AND METHODS: Sample of 1,460 PCPs in outpatient settings was drawn from a 2008 nationally representative survey of physicians. PCPs were classified into four categories based on distribution of practice revenue from Medicaid and Medicare and acceptance of new Medicaid patients. Fifteen in-depth telephone interviews supplemented analysis. FINDINGS: Most high- and moderate-share Medicaid PCPs report accepting "all" or "most" new Medicaid patients. High-share Medicaid PCPs were more likely than others to work in hospital-based practices (20%) and health centers (18%). About 30% of high- and moderate-share Medicaid PCPs worked in practices with a hospital ownership interest. Health IT use was similar between these two groups and high-share Medicare PCPs, but more high- and moderate-share Medicaid PCPs provided interpreters and non-physician staff for patient education. Over 40% of high- and moderate-share Medicaid PCPs reported inadequate patient time as a major problem. Low- and no-share Medicaid PCPs practiced in higher-income areas than high-share Medicaid PCPs. In interviews, difficulty arranging specialist care, reimbursement, and administrative hassles emerged as reasons for limiting Medicaid patients. POLICY IMPLICATIONS: PCPs already serving Medicaid are positioned to expand capacity but also face constraints. Targeted efforts to increase their capacity could help. Acceptance of new Medicaid patients under health reform will hinge on multiple factors, not payment alone. Trends toward hospital ownership could increase practices' capacity and willingness to serve Medicaid.

Health insurance and access to health care in the United States.

Health insurance, poverty, and health are all interconnected in the United States. This article synthesizes a large and compelling body of health services research, finding a strong association between health insurance coverage and access to primary and preventive care, the treatment of acute and traumatic conditions, and the medical management of chronic illness. Moreover, by improving access to care, health insurance coverage is also fundamentally important to better health care and health outcomes. Research connects being uninsured with adverse health outcomes, including declines in health and function, preventable health problems, severe disease at the time of diagnosis, and premature mortality.