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Market environment and Medicaid acceptance: What influences the access gap?

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  • Amelia Bond
  • William Pajerowski
  • Daniel Polsky
  • Michael R. Richards

Abstract

The U.S. health care system is undergoing significant changes. Two prominent shifts include millions added to Medicaid and greater integration and consolidation among firms. We empirically assess if these two industry trends may have implications for each other. Using experimentally derived (“secret shopper”) data on primary care physicians' real‐world behavior, we observe their willingness to accept new privately insured and Medicaid patients across 10 states. We combine this measure of patient acceptance with detailed information on physician and commercial insurer market structure and show that insurer and provider concentration are each positively associated with relative improvements in appointment availability for Medicaid patients. The former is consistent with a smaller price discrepancy between commercial and Medicaid patients and suggests a beneficial spillover from greater insurer market power. The findings for physician concentration do not align with a simple price bargaining explanation but do appear driven by physician firms that are not vertically integrated with a health system. These same firms also tend to rely more on nonphysician clinical staff.

Suggested Citation

  • Amelia Bond & William Pajerowski & Daniel Polsky & Michael R. Richards, 2017. "Market environment and Medicaid acceptance: What influences the access gap?," Health Economics, John Wiley & Sons, Ltd., vol. 26(12), pages 1759-1766, December.
  • Handle: RePEc:wly:hlthec:v:26:y:2017:i:12:p:1759-1766
    DOI: 10.1002/hec.3497
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    References listed on IDEAS

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    1. Frank Sloan & Janet Mitchell & Jerry Cromwell, 1978. "Physician Participation in State Medicaid Programs," NBER Chapters, in: The Economics of Physician and Patient Behavior, pages 211-245, National Bureau of Economic Research, Inc.
    2. Laurence C. Baker & Anne Beeson Royalty, 2000. "Medicaid Policy, Physician Behavior, and Health Care for the Low-Income Population," Journal of Human Resources, University of Wisconsin Press, vol. 35(3), pages 480-502.
    3. Abe Dunn & Adam Hale Shapiro, 2014. "Do Physicians Possess Market Power?," Journal of Law and Economics, University of Chicago Press, vol. 57(1), pages 159-193.
    4. Katherine Ho, 2009. "Insurer-Provider Networks in the Medical Care Market," American Economic Review, American Economic Association, vol. 99(1), pages 393-430, March.
    5. Sandra Decker, 2007. "Medicaid physician fees and the quality of medical care of Medicaid patients in the USA," Review of Economics of the Household, Springer, vol. 5(1), pages 95-112, March.
    6. Richards, Michael R. & Polsky, Daniel, 2016. "Influence of provider mix and regulation on primary care services supplied to US patients," Health Economics, Policy and Law, Cambridge University Press, vol. 11(2), pages 193-213, April.
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    Cited by:

    1. Elizabeth L. Munnich & Michael R. Richards, 2020. "Treatment flows after outsourcing public insurance provision: Evidence from Florida Medicaid," Health Economics, John Wiley & Sons, Ltd., vol. 29(11), pages 1343-1363, November.

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