Medicaid physicians said to be underpaid Doctors often refusing to treat poor patients.

April 02, 1991|By New York Times

WASHINGTON -- Medicaid, the health program for poor people, pays doctors much less than either Medicare or private health insurers for the same services. As a result, many doctors are refusing to take Medicaid patients, a federal advisory commission said yesterday.

In a report to Congress, the panel, the Physician Payment Review Commission, said Medicaid pays doctors 69 percent of what Medicare pays, and an even smaller proportion of what private insurers pay.

Forty-four states have problems getting doctors to participate in Medicaid, and "low fees were cited as the most common factor in discouraging participation," the commission said.

Medicare, the federal health insurance program for 33 million elderly and disabled people, has a much stronger political constituency than Medicaid, a federal-state program for 27 million poor Americans, including 13 million children.

While doctors have often complained informally about the level of Medicaid payments, the study by the commission is the most systematic attempt to date to measure the disparities.

The study, conducted with the help of the National Governors Association, was based in part on a survey of state Medicaid programs that reported data on actual fees for services commonly received by Medicaid beneficiaries.

Another reason for the disparity in doctors' fees under the programs is the the way the programs are financed. Medicare has its own trust funds, composed of payroll taxes, premiums and general revenues.

Medicaid, by contrast, depends almost entirely on general federal and state revenues.

The U.S. government decides how much to pay doctors under Medicare.

But states have wide discretion in deciding how much to pay in doctors' fees under Medicaid. And states often fail to update doctors' fees to take account of inflation. In some states, Medicaid pays less than it

costs for doctors to perform certain services.

The low Medicaid fees affect patients in several ways, the commission said: Medicaid recipients are less likely than other people to have a continuing relationship with a doctor, less likely to receive care in a private office and more likely to receive basic care in a hospital.

Doctors treating Medicaid patients may be at a "substantial economic disadvantage relative to their peers," the report said.

Payment gap


Dollar of Medicaid payments per dollar of Medicare payments.


Medicaid to

State Medicare

Alabama .72

Alaska 1.06

Arkansas 1.20

California .54

Colorado .81

Connecticut .56

Delaware .50

District of Columbia .51

Florida .71

Georgia 1.12

Hawaii .79

Idaho .76

Illinois .48

Indiana 1.02

Iowa .91

Kansas .79

Kentucky .63

Louisiana .66

Maine .62

Maryland .51

Massachusetts .94

Michigan .62

Minnesota .86

Mississippi .66

Missouri .57

Montana .74

Nebraska .99

Nevada .79

New Hampshire .67

New Jersey .40

New Mexico .69

New York .30

North Carolina .93

North Dakota .75

Ohio .60

Oklahoma .78

Oregon .66

Pennsylvania .51

Rhode Island .55

South Carolina .81

South Dakota .85

Tennessee .92

Texas .77

Utah .89

Vermont .71

Virginia .73

Washington .69

West Virginia .35

Wisconsin .76

* Arizona and Wyoming did not respond to the survey.

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