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A research team from the University of Oregon and New York University investigated factors affecting the likelihood of urban physicians accepting Medicaid coverage at their practice. The analysis revealed that “physicians are more likely to participate in Medicaid in counties whose poor are white and in areas that are racially integrated.”
Researchers utilized data from the 2000/2001 Community Tracking Study Physician Survey and the 2000 U.S. Census. The 9,178 study participants were physicians that had practices in metropolitan statistical areas and that were taking new patients.
“Physicians are more likely to participate in Medicaid in counties whose poor are white and in areas that are racially integrated.”
The study showed that 81% of all urban physicians accepted Medicaid patients (75% of primary care physicians and 84% of specialists). Additionally, Black physicians participated the most (90%), followed by Asian physicians (87%), White physicians (80%), and Latino physicians (78%). The authors noted that “those practicing in institutional settings, in lower-income counties, and in states with higher Medicaid/Medicare reimbursement rates were also more likely to participate in Medicaid.”
Researchers found that when less than 25% of the poor in the physician’s county were White, only 72% of all physicians participated in Medicaid. However, when the percentage of poor that was White was greater than 65%, there was an 88% participation rate. The racial makeup of the county’s poor had a greater impact on specialists than on primary care physicians. The effect was also larger for White and Asian physicians than for Black and Latino physicians.
Primary care physicians appeared to participate in Medicaid at a similar rate regardless of whether racial segregation levels were high or low. However, specialists’ participation levels actually decreased as racial segregation increased.
“Specialists’ participation levels in Medicaid decreased as racial segregation increased.”
Specifically, the results showed that if all other variables were held constant, both primary care physicians and specialists would be significantly more likely to accept Medicaid patients in counties that were in the highest quartile for the portion of poor that were White than in counties in the lowest quartile (83% vs. 72% and 97% vs. 86%, respectively).
The authors suggested that the study results may reveal that in some cases physicians’ conscious or subconscious “racial bias or stereotyping influenced his or her decision to participate in Medicaid.” Physicians in some locations may also be apprehensive about integrating nonwhite patients on Medicaid with those who are White and privately insured “because of the perception (real or otherwise) that their established patients would be uncomfortable sharing the waiting room with low-income minority patients.”
Source: Greene, Jessica, et al., Race, Segregation, and Physicians’ Participation in Medicaid, Millbank Quarterly. Volume 8 (2), Pgs. 1-16.
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