Despite an increase in physician fees, nearly half of all physicians in California's urban areas are unwilling to take patients enrolled in Medi-Cal, California's Medicaid program, according to research from the Medi-Cal Policy Institute, a division of the California HealthCare Foundation.
Just 56% of primary care physicians, 55% of medical specialists and 52% of surgical specialists said they treated Medi-Cal patients, according to a recent report based on a 2001 survey of a random sample of 1,762 physicians practicing in rural and urban areas in California.
"California's budgetary problems will force policymakers to think seriously about this program," says lead author Andrew Bindman, M.D., chief of general internal medicine at San Francisco General Hospital Medical Center, in a written statement. "Incremental efforts to increase physician participation have not been effective, and it is time to consider more far-reaching reforms in Medi-Cal and in the state's health care system overall."
Those efforts include the expansion of managed care in the late 1990s and an increase in physicians' fees in August 2000.
A core problem may be one of perception, the study finds.
"Fewer than one in seven physicians in 2001 indicated that they believed that Medi-Cal fees had increased in the past 18 months," the report says. "California would need to make a substantial investment in physician fees just to raise them to a level that is comparable to the average of other states' Medicaid physicians payment rates, let alone to the level of California commercial rates or the Medicare fee schedule.
Medi-Cal rates on average are only 65 percent of what Medicare pays for the same services.
Almost half of physicians were willing to accept new Medi-Cal patients, the report says. Among urban surgical specialists, for example, the percentage who refuse new Medi-Cal patients has doubled since 1998 to about 40%, although physicians in rural areas are more likely to participate than doctors in urban areas.
California is facing a multibillion-dollar budget deficit and likely will be forced to examine the Medi-Cal program and its policy objectives for physician participation, the report concludes.