Trends in payments for PCP visits show warning signs for patients with Medicaid
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If trends in total and out-of-pocket expenditures continue, Medicaid patients may have increasing difficulty accessing primary care physicians in the future, according to researchers.
Michael E. Johansen, MD, MS, a physician at Grant Medical Center in Ohio, and Jonathan D.Y. Yun, MD, MPH, a physician at Elmwood Primary Care in Maine, analyzed data from the Medical Expenditure Panel Survey to determine trends in total and out-of-pocket expenditures for primary care visits in the United States. Their analysis focused on 750,837 primary care visits between 2002 and 2017.
Johansen and Yun found that during that time, the proportion of primary care visits associated with private insurance or no insurance decreased, and visits associated with Medicare and Medicaid increased. The proportion of visits with $0 out-of-pocket expenditure significantly increased from 39.1% (95% CI, 37.8-40.5) in 2002 to 56.1% (95% CI, 54.7-57.5) in 2017. Visits with $0 out-of-pocket expenditure increased the most for private insurance — from 18.9% (95% CI, 17.6-20.3) to 37.8% (95% CI, 36.2%-39.4%).
The researchers also showed that the total expenditure per visit increased for private insurance and Medicare visits but not for Medicaid visits. Specifically, mean total expenditures increased annually by $5.36 (95% CI, 4.67-6.06) for those with private insurance, $3.19 (95% CI, 2.39-3.99) for those with Medicare coverage, and $0.38 (95% CI, –$0.21 to $0.98) for those with Medicaid.
Out-of-pocket expenses were driven primarily by increases in private insurance visits with higher expenditures of this type, according to Johansen and Yun. Mean out-of-pocket expenditures for visits increased by $0.37 per year (95% CI, 0.26-0.49) for patients with private insurance, $0.10 per year (95% CI, 0.04-0.06) for patients with Medicare, and $0.01 per year (95% CI, $0.03 to $0.06) for patients with Medicaid.
“Medicare and Medicaid had minimal change in out-of-pocket expenditure per visit,” the researchers wrote.
Johansen said the higher rate of growth in payments for primary care visits by patients with private insurance compared with Medicare and Medicaid “was one of the most interesting” findings.
“I worry a lot about this,” he continued. “If the differential growth continues to increase or fails to increase, I'd expect it to become continually harder for individuals and families with Medicaid to establish and maintain relationships with primary care physicians.”