Medicaid Physician Fees and Use of Primary Care Services: An Analysis of Recent Data Inclusive of ACA Fee Increase

We examine whether fees paid by Medicaid to primary care physicians affects the use of health care services with data that span the recent and large increases in fees mandated by the ACA. A difference-in-differences research design is used to obtain estimates of the association between Medicaid physician reimbursement and whether a person has a personal doctor (provider); whether a person had a routine check-up in the past year; whether a woman had a breast exam or a Pap test in the past year; whether a person had a dental visit or flu shot in the past year; whether a person has ever been diagnosed with asthma, diabetes, cardiovascular diseases, cancer, or chronic obstructive pulmonary disease; and whether a person had diabetes care in the past year. Data for the analysis are drawn from the Behavioral Risk Factor Surveillance System (BRFSS), which is one of the few sources of publicly available data that has the requisite information to conduct a study of this type. Results indicate that Medicaid fees for primary care are mostly unrelated to the use of services we examined with the exception that dental visits are positively, though modestly, associated with Medicaid fees. We conclude that Medicaid fees do not seem to have a major impact on the use of services; however, we note that our study looked at a narrow range of services due to data availability.