Objective: To test the accuracy of various physicians' participation in Medicaid models.
Data sources/study setting: Primary data on 221 obstetricians and gynecologists in the Chicago area by telephone interviews over a four-month period. These data were combined with secondary data from the American Medical Association Master File (1993) and U.S. Census data (1990).
Study design: Telephone interviewers posing as the older sisters of a pregnant teenager who is a Medicaid recipient sought information regarding the care provided in a first prenatal care appointment (e.g., appointment duration, tests administered, delivery privileges, appointment availability).
Data collection/extraction methods: A "receptionist helpfulness" variable was developed through pretesting on obstetricians in another city. Inter-interviewer reliability was enhanced through common interview technique education.
Principal findings: Only 81 obstetricians (36.7 percent) accepted new Medicaid patients. This finding is lower than previous research on physician participation in Medicaid. There was strong empirical support for both dimensions-cost containment and limited access-of the physicians' receptiveness model, the model introduced with this research. There was limited support for the dual market and residential segregation models of physician participation in Medicaid.
Conclusions: It is argued that this study's research design is more accurate in reflecting the barriers that a pregnant Medicaid-eligible patient encounters when seeking office-based prenatal care. As such, combining the physicians' receptiveness model with other physician participation in Medicaid models provides a more complete picture of access barriers to prenatal care for our most needy populations.
PIP: A survey of 221 obstetricians and gynecologists from Chicago, Illinois, sought to obtain an accurate estimate of physician participation in the Medicaid program. Female graduate students posing as the older sister of a pregnant teenager called physicians' offices seeking information on care provided during a first prenatal appointment. Overall, 81 (36.7%) of these physicians accepted new Medicaid patients for prenatal care. The participation rate was 44.1% among physicians with offices in Chicago (52.5% among those practicing in Chicago's poorest neighborhoods) compared with 24.7% among those with offices in the suburbs. Over 95% of receptionists categorized as "difficult" in their phone conversations with researchers worked for physicians who would not accept new Medicaid patients. Logistic regression analysis identified the following factors as significantly associated with Medicaid acceptance: first appointment duration under 20 minutes, appointment availability within 1 week, two or more tests administered, and high reception helpfulness. These findings suggest that attitudinal and organizational barriers further compound the low accessibility of office-based physician care to prenatal Medicaid patients. Physicians appear to manage their practices to attract certain patient types, and these recruitment practices are reflected in differing patterns of Medicaid participation.