Study Looks at Factors That Determine Physician Participation in Medicaid

Changes in physicians' decisions to treat Medicaid patients and the uninsured

In this 2001 to 2005 project, Phillip R. Kletke, PhD, from Health Research & Educational Trust and other researchers studied the factors that determine physician participation in Medicaid, including the extent to which physicians have discretion over their acceptance of new Medicaid patients and the effect that this discretion has on their Medicaid participation.

This project was part of the Robert Wood Johnson Foundation (RWJF) national program Changes in Health Care Financing and Organization (HCFO).

Key Findings

  • The researchers reported the following findings:

    • When determining whether to accept Medicaid patients:
      • 28 percent of physicians have individual discretion.
      • 56 percent make their decisions collectively with other physicians.
      • 14 percent follow the decision made by a board or another administrative body.
      • 2 percent make the decision in another, unspecified way.
    • Physicians with an ownership interest in their practices were more likely to have individual discretion over their Medicaid participation than were those who were employees.
    • Discretion over Medicaid participation varied significantly by specialty.