Working Paper: NBER ID: w26769
Authors: Pinka Chatterji; Sandra Decker; Jason U. Huh
Abstract: The objective of this study is to use data from the National Survey of Children with Special Health Care Needs (NS-CSHCN) to test whether Medicaid physician fees are correlated with access to health services and adequacy of insurance coverage among CSHCN. We use a difference-in-differences method, comparing the effects of Medicaid physician fees on outcomes of publicly-insured children in states that raised fees vs. in states that did not. We also consider a triple difference specification using privately-insured children as the comparison group. Our findings indicate that raising the Medicaid primary care fee level close to at least 90 percent of the Medicare level reduces the likelihood that publicly-insured CSHCN lack a usual source of care in a doctor’s office by about 15 percent. Fee increases are also associated with improved access to specialty doctor care, and large improvements in caregivers’ satisfaction with the adequacy of health insurance coverage, among publicly-insured CSHCN. Results for some other access measures, such as global measures of having difficulties and delays accessing services, were mixed.
Keywords: Medicaid; Physician Fees; Access to Care; Children; Special Health Care Needs
JEL Codes: I1; I13
Edges that are evidenced by causal inference methods are in orange, and the rest are in light blue.
| Cause | Effect |
|---|---|
| Raising the Medicaid primary care fee level to at least 90 percent of the Medicare level (I18) | Reduces the likelihood that publicly insured CSHCN lack a usual source of care in a doctor's office (I11) |
| Fee increases (D49) | Improved access to specialty doctor care (I11) |
| Fee increases (D49) | Greater caregiver satisfaction with the adequacy of health insurance coverage (G52) |
| Fee increases (D49) | Mixed results in access measures such as global measures of having difficulties and delays accessing services (I24) |
| Raising the Medicaid primary care fee level (I18) | Improved access to specialty doctor care (I11) |
| Raising the Medicaid primary care fee level (I18) | Greater caregiver satisfaction with the adequacy of health insurance coverage (G52) |