FACTORS ASSOCIATED WITH PEDIATRICIANS PARTICIPATION IN MEDICAID IN NORTH-CAROLINA

Objective. - To describe the relative importance of factors influencin g pediatricians' participation in Medicaid in North Carolina. Design. - Questionnaire survey. Setting and Participants. - Nonacademic primar y care pediatricians in direct patient care at least 50% of the time; 332 (85%) of the 389 eligible pediatricians responded. Main Outcome Me asures. - Proportion of pediatricians who restricted Medicaid patients ' access to their practices. The association between restricting acces s and the following factors was assessed: Medicaid reimbursement, pedi atricians' demographic characteristics, knowledge of the Medicaid prog ram, attitudes toward Medicaid patients and the Medicaid program, and beliefs about whether other physicians were available to care for Medi caid patients. Results. - Twenty-nine percent of pediatricians restric ted Medicaid patients' access to their practices. The proportion of pe diatricians restricting access was 62% in cities, 13% in medium-sized towns, and 12% in small towns (P < .001), but the proportion of pediat ricians in cities who restricted access varied from 87% to 22%. Pediat ricians who received a higher proportion of their usual fee were less likely to restrict Medicaid patients' access. The relationship between Medicaid payment and restricted access was substantially weakened aft er controlling for the following factors: (1) the size of the communit y, (2) pediatricians' attitudes toward Medicaid payment, (3) their per ceptions that they were too busy to care for Medicaid patients, and (4 ) whether there were other resources for the care of Medicaid patients . At comparable levels of payment, rural pediatricians were about six times less likely than urban pediatricians to restrict access. Pediatr icians who knew less about Medicaid reimbursement also restricted acce ss more often. Whether or not they restricted access to new Medicaid p atients, pediatricians provided acute, preventive, hospital, and emerg ency care to the Medicaid patients who were already in their practices . Conclusions. - Existing resources for the care of Medicaid patients, pediatricians' economic dependence on Medicaid, and the local norms o f practice may be important factors in pediatricians' decision to part icipate in Medicaid. Increasing reimbursement will have only modest ef fects on Medicaid participation. Strategies to improve participation s hould also address pediatricians' knowledge of the Medicaid program an d enlist the support of community physicians.