A Comparison of Two Approaches to Increasing Access to Care: Expanding Coverage versus Increasing Physician Fees
Version of Record online: 2 FEB 2012
© Health Research and Educational Trust
Health Services Research
Volume 47, Issue 3pt1, pages 963–983, June 2012
How to Cite
White, C. (2012), A Comparison of Two Approaches to Increasing Access to Care: Expanding Coverage versus Increasing Physician Fees. Health Services Research, 47: 963–983. doi: 10.1111/j.1475-6773.2011.01378.x
- Issue online: 8 MAY 2012
- Version of Record online: 2 FEB 2012
- Robert Wood Johnson Foundation
- Children's Health Insurance Program;
- physician utilization;
- physician fees;
- coverage expansion;
To compare the effects of a coverage expansion versus a Medicaid physician fee increase on children's utilization of physician services.
Primary Data Source
National Health Interview Survey (1997–2009).
We use the Children's Health Insurance Program, enacted in 1997, as a natural experiment, and we performed a panel data regression analysis using the state-year as the unit of observation. Outcomes include physician visits per child per year and the following indicators of access to primary care: whether the child saw a physician, pediatrician, or visited an ER in the last year, and whether the parents reported experiencing a non-cost-related access problem. We analyzed these outcomes among all children, and separately among socioeconomic status (SES) quartiles defined based on family income and parents' education.
Children's Health Insurance Program had a major impact on the extent and nature of children's insurance coverage. However, it is not associated with any change in the aggregate quantity of physician services, and its associations with indicators of access are mixed. Increases in physician fees are associated with broad-based improvements in indicators of access.
The findings suggest that (1) coverage expansions, even if they substantially reduce patient cost sharing, do not necessarily increase physician utilization, and (2) increasing the generosity of provider payments in public programs can improve access among low-SES children, and, through spillover effects, increase higher-SES children as well.