Biomaterial Database

Physician participation in Medicaid: background and issues. 1982

S M Davidson

Most Americans gain entry into the medical care system through office-based primary care physicians. The Medicaid program was created in 1965 in part to increase the access of low-income people to medical services in that mainstream. But, over the years, office-based physicians have reduced their treatment of Medicaid patients, and many have withdrawn from the program altogether. The result is not only that the original programmatic goal has not been fully achieved, but also that the costs of the program are higher than they would be otherwise. In this article, the importance of Medicaid participation by office-based primary care physicians is described, and a number of obstacles to their participation are identified. The obstacles include state policies regarding eligibility, coverage, and provider compensation. The article recommends actions pertaining to these policies that might increase participation.

UI	MeSH Term	Description	Entries
D007342	Insurance Benefits	Payments or services provided under stated circumstances under the terms of an insurance policy. In prepayment programs, benefits are the services the programs will provide at defined locations and to the extent needed.	Health Benefits,Insurance Beneficiary,Beneficiaries, Insurance,Beneficiary, Insurance,Benefit, Health,Benefit, Insurance,Benefits, Health,Benefits, Insurance,Health Benefit,Insurance Beneficiaries,Insurance Benefit
D007357	Insurance, Physician Services	Insurance providing benefits for the costs of care by a physician which can be comprehensive or limited to surgical expenses or for care provided only in the hospital. It is frequently called "regular medical expense" or "surgical expense".	Physician Services, Insurance,Services Insurance, Physician,Insurance Physician Service,Insurance Physician Services,Insurances, Physician Services,Physician Service, Insurance,Physician Services Insurance,Physician Services Insurances,Service, Insurance Physician,Services Insurances, Physician,Services, Insurance Physician
D008484	Medicaid	Federal program, created by Public Law 89-97, Title XIX, a 1965 amendment to the Social Security Act, administered by the states, that provides health care benefits to indigent and medically indigent persons.	Dental Medicaid Program,Medical Assistance, Title 19,Dental Medicaid Programs,Medicaid Program, Dental,Medicaid Programs, Dental,Program, Dental Medicaid,Programs, Dental Medicaid
D010548	Personal Health Services	Health care provided to individuals.	Health Services, Personal,Services, Personal Health,Health Service, Personal,Personal Health Service,Service, Personal Health
D011320	Primary Health Care	Care which provides integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. (JAMA 1995;273(3):192)	Primary Care,Primary Healthcare,Care, Primary,Care, Primary Health,Health Care, Primary,Healthcare, Primary
D012051	Reimbursement Mechanisms	Processes or methods of reimbursement for services rendered or equipment.	Mechanism, Reimbursement,Mechanisms, Reimbursement,Reimbursement Mechanism
D004608	Eligibility Determination	Criteria to determine eligibility of patients for medical care programs and services.	Eligibility Certification,Certification, Eligibility,Certifications, Eligibility,Determination, Eligibility,Determinations, Eligibility,Eligibility Certifications,Eligibility Determinations
D006291	Health Policy	Decisions, usually developed by government policymakers, for determining present and future objectives pertaining to the health care system.	Health Care Policies,Health Policies,Healthcare Policy,National Health Policy,Care Policies, Health,Health Care Policy,Health Policy, National,Healthcare Policies,National Health Policies,Policies, Health,Policies, Health Care,Policies, Healthcare,Policy, Health,Policy, Health Care,Policy, Healthcare
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D012959	Socioeconomic Factors	Social and economic factors that characterize the individual or group within the social structure.	Economic and Social Factors,Social Inequalities,Social Inequality,Social and Economic Factors,Socioeconomic Characteristics,Factors, Socioeconomic,High-Income Population,Land Tenure,Standard of Living,Characteristic, Socioeconomic,Factor, Socioeconomic,High Income Population,High-Income Populations,Inequality, Social,Living Standard,Living Standards,Population, High-Income,Socioeconomic Characteristic,Socioeconomic Factor,Tenure, Land