Medicaid Policy, Physician Behavior, and Health Care for the Low-Income Population

Concerns about the health of poor children and mothers produced major changes in the Medicaid public insurance program during the last decade, including expansions in program eligibility and increases in fees paid to physicians who care for covered patients. We examine physician responses to Medicaid policy changes aimed at improving care for pregnant women in order to understand the effects of Medicaid policy on physician behavior as well as to study the effectiveness of the expansions in improving access to care. While most previous studies have relied on data on physicians in private offices at a single point in time, we use repeated cross sections of data on young primary care physicians in a variety of practice settings. We find that expanded eligibility for Medicaid did increase access to physician services. However, contrary to the findings of some previous studies, increases in access are only apparent for the physicians in "public" institutions such as public clinics and hospital clinics; we find no evidence that increases in eligibility increase access to the physicians in our sample who are based in private offices. Our evidence also suggests that the impact of fees on physician behavior may be smaller than previous estimates would imply. We find that increases in fees are associated with increases in service to poor populations by these young private physicians, but some of this increase simply reflects shifting of patients from "public" sites to private physician offices