Medicaid Physician Fees and Access to Care among Children with Special Health Care Needs
Authors: Pinka Chatterji and Sandra Decker
The objective of this study is to test whether Medicaid physician fees are correlated with access to health services and adequacy of insurance coverage among children with special health care needs (CSHCN). We use a difference-in difference method, comparing the effects of Medicaid physician fees on outcomes of Medicaid-insured children versus privately-insured children. The study is based on pooled data from the 2005-2006 and 2009-2010 waves of the National Survey of CSHCN. The 2005-2006 survey includes data collected between April 2005 and February 2007, while the 2009-2010 survey includes data collected between July 2009 and March 2011. We merged into these data the state fee-for-service Medicaid to Medicare fee ratio for primary care visits. The main analysis sample is limited to CSHCN between 1 and 17 years old who either have private insurance coverage only or public insurance coverage only. We also estimate models using two narrower samples which include children who are likely to have more health services usage: a sample limited to CSHCN with mental/behavioral disorders; and a sample limited to CSHCN with mental/behavioral disorders or chronic medical conditions.
We estimate OLS models with sample weights. In future work, we will use probit models for dichotomous outcomes. The standard errors are adjusted for clustering on state. The paper will examine effects of Medicaid physician fees on a range of parent-reported outcomes related to access to care and adequacy of insurance among CSHCN. Our preliminary findings are based on models of the following binary measures of access to care and adequacy of health insurance coverage: (1) In past 12 months, child did not get all routine care s/he needs due to cost or insurance reasons; (2) In past 12 months, child did not get all specialty physician care s/he needs due to cost or insurance reasons; (3) In past 12 months, child did not get all mental health care s/he needs due to cost or insurance reasons; (4) insurance benefits and coverage usually/always meet child’s needs; (5) costs covered by insurance are usually/always reasonable; (6) insurance allows child to usually/always see the providers s/he needs.
Preliminary indicate that a higher Medicaid to Medicare fee ratio for reduces the likelihood that parents of CSHCN insured by Medicaid report that their child lacked access to routine care due to cost and insurance reasons. We also find that higher Medicaid to Medicare fee ratios increase the likelihood that parents of CSHCN insured by Medicaid report that their health insurance usually or always meets their child’s needs. Findings for other outcomes are not statistically significant. In future work, we plan to refine these models, explore a broader range of outcomes, and add data from the 2001 wave of the National Survey of CSHCN.