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Biomedical subjects

P R Kletke

Publications and source records attributed to P R Kletke.

18 recordsLinked to original sources
PubMed1997

Medicaid participation among urban primary care physicians.

OBJECTIVES: This article describes Medicaid participation among office-based primary care physicians in cities and examines its determinants. METHODS: Data used in this study were collected through the 1993 and 1994 American Medical Association Socioeconomic Monitoring System telephone surveys. The sample includes 1,300 primary care physicians. Our multivariate model includes a variety of personal, practice, community, and policy factors thought to influence participation. Logistic regression was used to examine determinants of accepting any Medicaid patients and ordinary least square regression was used to examine determinants of the extent of participation among participants. RESULTS: The authors found that 19% of respondents did not participate in Medicaid and 62% had practices with 9% or fewer Medicaid patients. Multivariate analyses indicated that Medicaid payment levels were not associated with observed patterns of Medicaid participation. Community sociodemographic characteristics and demand from Medicaid-eligibles, by contrast, play a significant role in influencing observed levels of participation. CONCLUSIONS: Strategies other than raising Medicaid payment levels will be needed to achieve equitable access to office-based primary care for the poor residing in cities.

Ambulatory Care↗
PubMed1996

Current trends in physicians' practice arrangements. From owners to employees.

OBJECTIVE: To examine current trends in practice organization among postresident patient care physicians in the United States. DESIGN AND SETTING: The American Medical Association's Socioeconomic Monitoring System (SMS), a series of periodic surveys of nationally representative samples of nonfederal postresident patient care physicians. Physicians were divided into 3 categories based on the organization of their main practice. They were classified as employee physicians if they had no ownership interest in their practice, as self-employed solo physicians if they were in 1-physician practices in which they had an ownership interest, and as self-employed group physicians if they were in multiple-physician practices in which they had an ownership interest. PARTICIPANTS: Nonfederal, postresident patient care physicians who provided more than 47 000 responses to SMS surveys between 1983 and 1994. MAIN OUTCOME MEASURE: The proportion of nonfederal postresident patient care physicians who were employees between 1983 and 1994. RESULTS: Between 1983 and 1994, the proportion of patient care physicians practicing as employees rose from 24.2% to 42.3% (P<.001), the proportion self-employed in solo practices fell from 40.5% to 29.3% (P<.001), and the proportion self-employed in group practices fell from 35.3% to 28.4% (P<.001). Most of these changes occurred in the latter half of the 12-year period. These trends, which are evident in virtually every segment of the patient care physician population, are especially prominent among young physicians. The growing proportion of employee physicians is associated with increases in the earnings of employee physicians relative to those of self-employed solo physicians. CONCLUSIONS: Current trends in the US health care system are rapidly changing the career opportunities of patient care physicians and, hence, physicians' choice of practice arrangement.

Group Practice↗
PubMed1992

Medicaid and access to child health care in Chicago.

In this article we examine how increasing the reimbursement of physicians and expanding Medicaid eligibility affect access to care for children in Cook County, Illinois, which overlies Chicago. Using Medicaid claims and other data at the zip-code level, we compare the places where Medicaid children live with the places where all the physicians who treat children and those who accept Medicaid patients have their practices. Our findings suggest that the recent changes in legislation are unlikely to benefit extremely poor children, who are more likely to live in depressed inner-city areas, where there are few physicians. "Near-poor" children whose homes are dispersed throughout the county, who are now eligible for Medicaid as a result of the recent changes, are likely to see improvements in their access to care. Further changes in policy, aimed at enhancing the capacity of institutions providing care, could improve access for the children of the inner city.

Adolescent↗
PubMed1991

The supply of renal physicians: an analysis of data from the American Medical Association Physician Masterfile.

This study uses data from the American Medical Association (AMA) Physician Masterfile to describe current demographic trends among physicians specializing in adult and pediatric nephrology. The analysis shows that renal physicians are younger than the physician population as a whole. Compared with other specialty groups, renal physicians are less likely to be in patient-care activities and are more likely to be in research. In recent years, the population of renal physicians has grown at a much faster rate than the rest of the physician population. A projection analysis indicates that the adult nephrologist population will more than double in size between 1987 and 2010. Among adult nephrologists, the number of women is expected to grow much faster than the number of men. Rapid growth is expected in the older age categories, whereas the number of adult nephrologists 35 years of age and younger is expected to decrease slightly.

Adult↗
PubMed1991

Medicaid patients' access to office-based obstetricians.

Recent expansion of the eligibility of low-income pregnant women for Medicaid-funded prenatal care may be jeopardized by undersupplies of obstetricians and gynecologists (OB/GYNs) in rural and urban low-income areas and by widely reported declines in the number of OB/GYNs willing to accept Medicaid patients. This paper examines the availability of office-based obstetric care to Medicaid patients in Illinois. We present and test a model of the determinants of Medicaid participation by private, office-based OB/GYNs that highlights the role of residential segregation and practice economics. We find that a large growth in demand for obstetrical care or the enhancement of Medicaid fees is unlikely to have a major effect on OB/GYN participation in Medicaid. We conclude that improving access will require expanding the supply of providers in underserved areas.

Eligibility Determination↗
PubMed1991

The role of local hospitals in physician rural location decisions.

This study has two objectives. First, it identifies how much the presence of community hospital beds adds to the stock of physicians practicing in nonmetropolitan counties. Second, it estimates the impact hospital closures or other reductions in beds have on the net flow of physicians into rural counties. The study relies primarily on data from the 1981 and 1986 Physician Masterfiles of the American Medical Association. We find that hospital bed reductions and closures essentially do not affect the availability of physicians--they have apparently already left by the time the downsizing occurs. Further, population change and the number of physicians already in the county determine for the most part the entry or exit of physicians.

Career Choice↗
PubMed1990

The growing proportion of female physicians: implications for US physician supply.

This study analyzes how the growing proportion of women in the United States physician population will affect the amount and type of physician services available to the US population. Female physicians work fewer hours per week, are slightly less likely to be in patient care, and tend to enter different specialties than male physicians. Female physicians also have higher retirement rates than male physicians, but due to their lower mortality rates, have work lives nearly as long as male physicians. We examined how the changing composition of the physician population will affect the availability of physician services by comparing historical and projected trends for the number of active post-residency physicians with comparable trends for a full-time-equivalent measure of physician supply. The full-time-equivalent measure takes into account the different labor supply behavior of key subpopulations (e.g., women and graduates of US versus foreign medical schools). The results suggest that the changing composition of the physician population will reduce the growth of effective physician supply between 1986 and 2010 but only by four percentage points.

Adult↗
PubMed1990

Medicaid in the inner city: the case of maternity care in Chicago.

The growing concentration of lower-income groups, including Medicaid patients, in homogeneous inner-city areas such as Chicago casts considerable doubt on the effectiveness of expanding Medicaid eligibility and raising physician reimbursement to improve access to maternity care. There are few private office-based physicians providing prenatal care in these areas, and most pregnant women and infants are treated by private-office-based physicians in very high-volume practices, prompting concern about the quality of care. Increasing the supply of providers is required to enhance access to maternity services in inner cities. Expanding eligibility and raising reimbursement rates are more apt to benefit "near-poor" women, who are more spatially dispersed, than clustered-poor female populations.

Aid to Families with Dependent Children↗
PubMed1987

Physicians' decisions to limit Medicaid participation: determinants and policy implications.

Although most primary care physicians participate in state Medicaid programs, they may accept all Medicaid patients, or they may choose to limit their participation. This decision allows physicians to adjust their Medicaid caseloads to a desired level, and it has important implications for the access of low-income patients to health care. Surveys of pediatricians in 1978 and 1983 indicate that the proportion of pediatricians limiting their Medicaid participation increased significantly from 26 percent to 35 percent (p less than .001). In addition, in both 1978 and 1983, limited participants saw significantly fewer Medicaid patients than full participants. This paper describes a number of strategies available to federal and state policymakers for fostering full Medicaid participation. Multivariate analyses indicate that increasing reimbursement levels is an important strategy for encouraging full Medicaid participation. In addition, full participants will increase their Medicaid caseloads in response to a variety of Medicaid policy incentives, while limited participants are found to respond to fewer policy incentives. The authors conclude that caution will be needed to ensure that health care cost-containment strategies such as capitation or selective contracting do not inadvertently discourage participation among both full and limited Medicaid participants.

Health Services Accessibility↗
PubMed1987

Changes in the supply of internists: the internal medicine population from 1978 to 1998.

Between 1978 and 1985, the number of active internists in the United States increased from 64,000 to 91,000, and by 1998 the number will have increased to 141,000. This growth represents an increase of 121% for a 20-year period, during which time the population of the United States is expected to increase only 19%. Thus, the number of adults older than 17 years per active internist will drop from 2464 to 1401. Between 1978 and 1998, we expect the number of subspecialty internists to increase 206%, in contrast to a 77% increase expected for general internists. The proportion of female internists will increase from 7% to 21%. The proportion of the active internist population who are foreign medical graduates will remain stable at about 21% throughout the projection period, but within this group the proportion who are United States citizens is expected to increase while the proportion who are foreign citizens is expected to decline.

Adult↗
PubMed1986

Recent trends in pediatrician participation in Medicaid.

Many Medicaid policy changes occurred in recent years including those resulting from the Omnibus Budget Reconciliation Act of 1981 and the Tax Equity and Fiscal Responsibility Act of 1982. At the same time, the supply of providers increased and the health care market became more competitive. This paper presents evidence about how these developments are affecting pediatricians' participation in state Medicaid programs. Surveys conducted in 1978 (N = 814) and 1983 (N = 791) indicate that the proportion participating declined only slightly from 85.1% to 82.0%. The average Medicaid case load of participants remained at 15%, although extent of participation of individual pediatricians fluctuated. Previous research demonstrates that physicians' Medicaid participation is affected by reimbursement level, administrative complexity, and generosity of eligibility and benefits. Our data confirm these influences. However, the longitudinal design of the analyses reported here also captures shifts in the relative influence of these factors. The influence of policy factors has diminished over time, while the influence of changes in physician supply has increased. Increased physician supply, however, is associated with decreased Medicaid participation. Thus, diminished access to pediatric care for low-income children may result from recent changes in Medicaid and in the broader health care environment.

Health Services Accessibility↗
PubMed1986

Pediatrician participation in Medicaid--findings of a five-year-follow-up study in California and elsewhere.

Medi-Cal-California's Medicaid program-underwent significant changes during the period 1978 through 1983. Most notable were the imposition of new copayments, reductions in physician reimbursement and selective contracting for hospital services. The state-funded medically indigent program was transferred to the counties and the state began to experiment with bulk purchasing of drugs and supplies, a lock-in for overutilizers and primary care case management. How have these changes affected primary care providers' participation in Medi-Cal? Surveys of California pediatricians in 1978 and 1983 suggest that while most continue to participate, the level of limited participation in Medi-Cal increased from 23% to 51%. Most pediatricians express discontent with the level of Medicaid payments and there is a growing sentiment that Medicaid regulations interfere with the provision of high quality medical care. Future Medi-Cal policy developments, such as contracting for physician services, should be structured in ways that maximize participation of primary care providers in the program.

Attitude of Health Personnel↗
PubMed1985

The extent of physician participation in Medicaid: a comparison of physician estimates and aggregated patient records.

This article compares two measures of the extent of physician participation in Medicaid programs. The first, which has been used in most research to date on the subject, is based on physician estimates of the proportion of their patients who are Medicaid patients. The second derives from encounter forms for a sample of visits to the interviewed physicians. The comparison shows that physicians in the sample tended to overestimate by 40 percent the extent of their Medicaid participation. Because the two measures are highly correlated, the analysis of the determinants of Medicaid participation was not affected by the measure used. However, since physicians tended to overstate the proportion of Medicaid patients in their practices, interview data should not be used to measure the amount of physician participation or to calculate elasticities for the effects of policy changes on the extent of participation.

Data Collection↗
PubMed1983

Full and limited medicaid participation among pediatricians.

Participation in Medicaid by pediatricians is an important element in the access of low income children to health care. Factors that influence whether participating pediatricians choose to participate fully in the program or to limit their acceptance of Medicaid patients are identified and analyzed. Data were derived from interviews conducted with 814 pediatricians in 13 states. A multivariate analysis examining physician, practice, service area, and Medicaid policy characteristics indicates that policy factors are most influential in the physician's decision whether to participate fully in medicaid programs. Factors found to foster the willingness of pediatricians to participate fully in state Medicaid programs included more competitive levels of reimbursement, minimal delays in reimbursement, and eligibility and benefit policies that minimize interference with the exercise of medical judgment.

Fees and Charges↗
PubMed1982

Current distribution and trends in the location pattern of pediatricians, family physicians, and general practitioners between 1976 and 1979.

The literature suggests that pediatricians in the United States are concentrated in the more densely populated regions and states, whereas family physicians and general practitioners are more likely to settle in rural areas. The rapidly increasing supply of all child health physicians had led many to hypothesize that the traditional geographic preferences of pediatricians would expand to include smaller communities. Data for 1976 to 1979 confirm the urban concentration of pediatricians and the more even distribution of family physicians and general practitioners. These data also demonstrate a marked imbalance of pediatricians within county groups, resulting in some areas of shortage even within highly metropolitan communities. Evidence of a trend toward increased dispersion of pediatricians into urban shortage areas is presented, but there is no indication that enough pediatricians will settle in rural areas to meet the needs of children in those small communities.

Medically Underserved Area↗