| Despite increases in program enrollment, sources report that the proportion of U.S. office-based physicians willing to accept Medicare and Medicaid patients is decreasing. This healthcare economics based, managerial accounting study utilizes a national survey of practicing physicians to explore this conundrum from the physicians' perspective. Specifically, the impact of organizational-related determinants including (1) practice characteristics, (2) compensation and (3) performance measures is examined on physicians' propensity to accept new Medicare and Medicaid patients. With an empirical analysis using the cumulative odds ordinal logit model, this study breaks new ground in several significant venues. No study has yet examined physician practice characteristics relative to physician acceptance of Medicare patients and the limited number that have for Medicaid were far more limited in scope. In addition, the impact of financial incentives in and of themselves on physician propensity to accept new Medicare and Medicaid patients is explored. Finally, this study offers a first look at how financial and non-financial incentives collectively impact patients' access to Medicare and Medicaid.;The most significant factors associated with diminished propensity for access include: operating as a primary care doctor, physician ownership in the practice, a noncompetitive marketplace environment, high relative geographic cost/low reimbursement, variable and low levels of physician compensation. Additionally, practice size and supportive clinical IT were found significant on the Medicaid outcome only.;Identified herein are the underlying financial pressures that pose the greatest threat to limiting physicians. Inadequate reimbursement is the chief concern. Billing issues, delayed reimbursement and capacity constraints are further acknowledged. |
