Changes in physician income and practice arrangements make physicians less willing to accept Medicaid and uninsured patients, and physicians moving into different practice arrangements tend to treat either charity-care patients or Medicaid patients but not both, according to a study by the Center for Studying Health System Change. More specifically, while a decline in income increased the likelihood that physicians would stop accepting new Medicaid patients, it had no effect on their decision to provide charity care, according to the study.
On the other hand, physicians who switched from being owners to employees or from small to larger practices were more likely to drop charity care and to start accepting Medicaid patients. Physician who made the opposite changes did the reverse. Earlier research showed that the proportion of U.S. physicians providing charity care declined from 76.3% in 1996-97 to 68.2% in 2004-05.
To reverse the trend, the authors suggested that policymakers should consider raising reimbursement rates and subsidizing organizations that encourage private doctors to provide charity care. The study was based on data from four rounds of a nationally representative community tracking survey over a 10-year period from 1996 through 2005. The study, Effects of Changes in Incomes and Practice Circumstances on Physicians Decisions to Treat Charity and Medicaid Patients was published in the March edition of the Millbank Quarterly. -- by Cinda Becker