Nearly Half of State’s Doctors Will Not Treat Medi-Cal Patients
State’s care for the poor endangered, according to UCSF researchers
Nearly half of the physicians in California are unwilling to accept new patients covered by Medi-Cal, the state’s health insurance program for low-income families and elderly, blind and disabled individuals, according to a survey conducted by researchers at the University of California, San Francisco and published by the California HealthCare Foundation’s Medi-Cal Policy Institute (MCPI). The report, Physician Participation in Medi-Cal, 2001, finds that the supply of physicians available to Medi-Cal patients is significantly less than that available to the general population.
On average, the number of available primary care physicians per capita for Medi-Cal beneficiaries in 2001 was 34% less than it was for the general population. The number of medical specialists available to Medi-Cal beneficiaries was 60% less than it was for the general population, and the number of surgical specialists was 67% less. Physician participation rates in Medi-Cal were also substantially lower than for the other major public insurance program, Medicare.
“The findings from this survey raise concerns about whether there is an adequate supply of physicians to care for the more than six million Californians who are enrolled in Medi-Cal,” noted Lucy Streett, program officer at MCPI. “Although the state increased Medi-Cal physician payment rates significantly in 2000, Medi-Cal rates are on average only 65% of what Medicare pays for the same services. Given the 15% physician payment rate reduction included in the Governor’s proposed budget, Medi-Cal beneficiaries’ access to care could get worse before it gets better.”
The study also found that, despite efforts in the late 1990s to increase physician participation in the Medi-Cal program, including the expansion of Medi-Cal managed care and an increase in physician fees, there was no measurable increase in physicians’ participation in the program between 1996 and 2001. Exacerbating the problem, Medi-Cal is now imperiled by state budget cutbacks and is facing significant reductions in funding.
“California’s budgetary problems will force policymakers to think seriously about this program,” said Andrew B. Bindman, M.D., chief of the department of general internal medicine at San Francisco General Hospital Medical Center, who led the study. “Incremental efforts to increase physician participation have not been effective, and it is time to consider more far-reaching reforms in Medi-Cal and in the state’s health care system overall.” Bindman’s team conducted a random survey of 1,762 state primary care and specialist physicians in 2001, then compared the results to similar surveys conducted in 1996 and 1998.
Among the study’s findings:
- In California’s urban counties, just half of primary care physicians, medical specialists, and surgeons have Medi-Cal patients in their practices. Participation rates are far higher in remote rural areas, where 79% of primary care physicians, 77% of medical specialists, and 85% of surgical specialists serve Medi-Cal patients.
- Nearly half of the state’s physicians, urban and rural, are unwilling to accept new Medi-Cal patients. Among urban surgical specialists, for instance, the percentage who refuse new Medi-Cal patients has doubled since 1998 to about 40%.
- Twenty-five percent of the state’s primary care physicians provide 80% of the primary care visits to Medi-Cal patients.
- According to federal workforce standards, 60 to 80 primary-care physicians should be available per 100,000 residents. In California’s urban counties, only 46 primary care physicians are available per 100,000 Medi-Cal patients.
- In 2001, physician participation rates in Medi-Cal were substantially lower than for the other major public insurance program, Medicare. With the exception of pediatricians, between 74% and 97% of the physicians in the surveyed specialties reported that they had Medicare patients in their practice, compared to a range of 28% to 71% for Medi-Cal.
- Physician dissatisfaction with Medi-Cal is deepening. In 1996, about two-thirds of physicians expressed optimism that managed care would increase reimbursement for Medi-Cal patients. In the most recent survey, that figure was 28%. The problem may be one of perception. Although Medi-Cal reimbursement rates rose in 2000, most physicians were unaware of the increase when surveyed in the fall of 2001, according to UCSF researchers. In addition to Bindman, authors of the new analysis are Kevin Grumbach, M.D., and Jean Yoon, M.H.S., both of the UCSF Center for the Health Professions; and Lucy Streett, M.P.H., of the Medi-Cal Policy Institute.The survey was supported by the California HealthCare Foundation and the National Center for Health Workforce Analysis. The complete report is available online through the link below.
About the UCSF Center for the Health Professions
The UCSF Center for the Health Professions assists health care professionals, health professions schools, care delivery organizations and public policy makers respond to the challenges of educating and managing a health care workforce capable of improving the health and well being of people and their communities. Visit http://futurehealth.ucsf.edu for more information.
About the California Health Care Foundation
The California Health Care Foundation is dedicated to advancing meaningful, measurable improvements in the way the health care delivery system provides care to the people of California, particularly those with low incomes and those whose needs are not well served by the status quo. We work to ensure that people have access to the care they need, when they need it, at a price they can afford.