Low Medicaid payments are threatening the quality of health care for many minority patients and is contributing to racial disparities in health care, according to a new study released last Tuesday.
The physicians treating high numbers of minority patients report having inadequate time with patients and numerous other problems.
Their findings were released in a study last week in “Health Affairs,” a medical journal on health policy.
In conducting the report, researchers first identified physicians in low-, medium- and high-minority practices. They found that a relatively small number of physicians, 12 percent, had practices that treated more than 70 percent minority patients.
Those physicians, the study found, typically earn less, treat more patients and receive lower private insurance payments.
The study concluded that, “low [Medicaid] payments may be leading primary care physicians to reduce the time spent with patients and generally diminish their ability to function effectively as their patients’ medical home.”
The Center for Studying Health System Change, based in Washington, D.C., conducted the report, which was funded by the Commonwealth Fund.
“Increasing Medicaid reimbursements to providers that are on par with Medicare [for seniors] or private insurance could reduce the disparities,” said James D. Reschovsky, senior researcher for Health System Change. “One could [also] direct subsidies to physicians who choose to treat patients in high minority and low income areas.”
Increasing Medicaid reimbursements could help move the United States toward a high-performance healthcare system, said Dr. Anne C. Beal, assistant vice president of the Commonwealth Fund.
The Health Affairs report is based on findings from Health System Change’s 2004-05 Community Tracking Study Physician Survey, as well as from the U.S. Census Bureau. The study included information from 3,320 primary care physicians, such as general internists, family/general practitioners and pediatricians.
“I think the primary contribution of the article is to illustrate how racial and ethnic disparities are a function of broader systemic disparities in our society,” Reschovsky said. “Due to the fact that minority and low-income people are geographically concentrated, they are treated by a small number of physicians.”
Other factors, such as language barriers and increased numbers of patient visits a day also contributed to the poor quality of care minority patients receive. Physicians in high-minority practices spent 30 percent less time with patients compared to patients seen at low-minority practices.
“Those physicians tend to squeeze more patients in, in the course of an hour,” Reschovsky said. “Bottom line is that some disparities in health care are attributable to the resource base of the physician practice.”
Those physician’s practices received more than a third of their revenue from Medicaid-more than twice that of physicians with less than 30 percent minority patients.
Furthermore, the study found that 35 percent of primary care physicians in high-minority practices reported patients’ inability to pay as a major problem.
“The other major way to reduce disparities is to expand health insurance coverage for people who are currently uninsured,” Reschovsky insisted. Those people, he said, “tend to be minorities and low-income individuals.”
