Wednesday, October 3, 2007

Where are the doctors who accept Medicaid?

One of the plans being considered by the 208 Commission would radically expand Medicaid, and essentially fold all of the middle class into a government program that was initially intended to cover the poorest patients.

However recent experience in Utah shows, this will not solve the problem. Utah Medicaid patients can't get the care they need because the amount of money that the state pays doctors is so little that they can't afford to see Medicaid patients. But the high costs of a government-run system divorced from marketplace incentives means that the state won't pay more money. The result is that even though the patients have paper "coverage", they don't receive actual care. (States do not yet require physicians to take Medicaid patients despite losing money on each one - if they did, that would be outright slavery.)

Here are some excerpts from a recent article in the 9/17/07 Salt Lake City Tribune about Utah Medicaid:
Where are the doctors who accept Medicaid?

Sergey Sargsyan has lost 80 pounds since his symptoms began more than three months ago. He's in pain and getting weaker. Emergency room visits and surgery to remove gallstones have done little to help. Doctors say he needs a specialist.

...But finding one willing to accept Medicaid as payment has been an exercise in futility, said Susanna McPhilomy, the 77-year-old's daughter. "The first question isn't, 'How can we help you?' " she said, "but, 'What type of insurance do you have?'"

Sargsyan is not alone. Health care experts are seeing the first of what they say could become widespread lack of access to care for Medicaid patients.

...Specialists are in even shorter supply. In 2007, eight specialty groups had zero Medicaid billings: abdominal surgeon, cardiovascular surgeon, geriatrician, hand surgeon, head and neck surgeon, neuroradiologist, pediatric radiologist and therapeutic radiologist. That means patients are going to the emergency room for specialty care, said Fotheringham.

"You hope, at that point, the guy you need is on-call," he said. "And there are some doctors, such as orthopedic specialists, who won't work on-call for the simple reason they don't get paid."

Lincoln Nehring, an analyst at the Utah Health Policy Project, said he has also started to hear of Medicaid patients being pushed to emergency rooms for primary care.

Another common practice is for doctors to space their Medicaid patients, which can mean monthlong waits, said Nehring.
Note that these "monthlong waits" are defacto rationing. Why should we adopt a failed system like this as the basis for health care "reform" in Colorado? (Via KevinMD.)