Citation URL: http://www.urban.org/StephenANorton

This study used data from a state survey to show that Medicaid physician fees grew by 4.6 percent between 1993 and 1998, below the rate of inflation. This growth was greater, on average, for primary care services than obstetrics, surgery or other services. Relative to Medicare physician fees, Medicaid fees fell by 14.3 percent between 1993 and 1998. Medicaid’s low fees and slow growth rates suggest that potential access problems among Medicaid enrollees remain a policy issue. (Health Affairs 2000 July/August; 19(4):222-232)

Paper will review evidence from survey on setting capitation rates, asking such questions as: Do states use competitive bidding, negotiations, or rate setting? How are rates set? What are the rates for different groups? How do states adjust for risk? Do they adjust for safety net providers?

Health status affects many aspects of people's daily lives. For adults, poor health can reduce earnings, increase expenses for medical care, and make it difficult to care for their families. For children, poor health can limit their ability to attend school regularly and to interact socially with other children. Although health status depends on heredity, environment, and a wide range of other factors, policy makers may be able to improve health status by increasing access to medical care.

This study used data from 1986 through 1992 to estimate the “volume offset” that may occur when payment rates for Medicare physician services are changed. Although policymakers assume that 50 percent of all fee reductions are offset by volume increases and that this occurs across all type of services, this analysis does not support that position. There is a “volume offset,” but it is generally smaller than 50 percent. For evaluation and management and imaging services, an offset of about 25 percent would seem appropriate. Although the 50 percent assumption for procedures is consistent with this study, our analysis suggests that an offset occurs in response to fee increases as well as decreases. (Medical Care Research and Review 1998 December; 55(4):457-458).

There are two Highlights for each state. The Highlights that focus on health cover Medicaid, other public insurance programs, the health care marketplace, and the role of public providers. The Highlights capture policies in place and planned in 1996 and early 1997.

This report provides detailed descriptions of safety net health care systems and the market and policy circumstances in which safety net providers operate in eight communities across the United States. A brief overview of the safety net system and safety net provider responses to changes in competition provide a framework for assessing the current and future outlook for the safety net system in each community.

Despite significant changes in the market and policy environment, major safety net hospitals and clinics have so far been able to maintain their commitment to the uninsured. While several factors are making it harder for safety net providers to provide care to the uninsured, this paper finds that very few have closed and none of the major providers have reported reductions in their capacity to care for the uninsured. The authors identify and discuss three primary reasons for the resilience of these health care providers.

The state reports describe the safety net and health care programs in place for low-income people on the eve of welfare reform. The reports also analyze the particular circumstances that are shaping the state's response to the Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA). The state reports are based on case studies in the respective state.

There are two Highlights for each state. The Highlights that focus on health cover Medicaid, other public insurance programs, the health care marketplace, and the role of public providers. The Highlights capture policies in place and planned in 1996 and early 1997.

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