USING MEDICAID CLAIMS DATA TO EVALUATE A LARGE PHYSICIAN FEE INCREASE

Objective. This study demonstrates the use of Medicaid claims data in order to evaluate a threefold fee increase in physician fees for deliv eries ($265 to $795), which the Maryland Medicaid program implemented in 1986. Data Sources and Study Setting. The study used Maryland Medic aid claims data for years of service 1985-1988, and was done at the Ma ryland Department of Health and Mental Hygiene with the help of a Robe rt Wood Johnson, Health Care Financing and Organization (HCFO) grant. Study Design. Overall, our design is that of a pre-test, post-test wit h multiple observation points both before and after the fee increase. We measured participation in three ways, cor-responding to three diffe rent units of analysis. With the county-quarter year as unit of analys is, we followed a panel of providers over 16 quarters for each county in the state to determine changes in the number of delivering provider s. With the individual provider as the unit of analysis, we identified effects on their Medicaid caseload between years that may have been i nfluenced by the fee increase. Finally, we looked at continuously enro lled Medicaid women who delivered to determine the effects of the fee increase on site and volume of prenatal care. Data Collection/Extracti on Methods. Analytic files for each unit of analysis were compiled fro m previously extracted Medicaid claims files using standard statistica l software packages. Principal Findings. Using techniques described, w e were able to get an in-depth picture of overall responsiveness to th e intervention. We found a moderate influence of the fee increase on o verall participation, less than what we would have predicted. Conclusi ons. Administrative data can be used to construct efficient, yet sophi sticated evaluations of major policy changes. Findings from our evalua tion suggest a moderate effect of the fee increase on overall particip ation. However, raising fees to the level of private third party payer s does not in itself guarantee equal access to private physician healt h care for Medicaid mothers.