Physician Participation in Medicaid Managed Care PDF Download

Author: Sunday E. Ubokudom
Publisher: Garland Science
ISBN: 9780815329053
Category : Medical
Languages : en
Pages : 199

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Book Description
Health care policy and proposals for national health care reform have become some of the most contentious political issues of the decade. Garland Publishing announces a new series addressing the most significant issues in the area of health care policy and the business of health care in the United States. books in this multidisciplinary series will include studies of health care practice, the health care business, the implications of multicultural perspectives on health care for public policy, the impact of insurance on health care, and debates over national health care policy, including health care reform. This collection of timely works will offer significant scholarly perspectives on one of the most important issues in public policy.Vital information for policy makingThis book analyzes factors influencing physician participation in the Kansas Primary Care Network (PCN), a case management program for Medicaid beneficiaries. Studies of Medicaid managed care programs have examined the ability of these programs to control program expenditures, but there has been little research on physician participation. Since 1981, enrollees in the managed care programs of Medicaid have increased by 4,204 percent. A study that identifies the factors that enhance or impede physician participation in a Medicaid managed care plan is vital to health care policy making.What influences doctor participationThe study finds nine factors that influence physician participation in the PCN program -- receptivity to capitation-based reimbursement; county per capita income; relative fees; delayed payment; specialty referrals; practice organization; years in practice; the intermittent eligibility ofclients for Medicaid; and the perception that Medicaid clients are likely to be late for appointments. These findings reaffirm the two-market theory of the United States health care system. Because most providers treat patients with private health insurance coverage, which off