Journal
MEDICAL CARE RESEARCH AND REVIEW
Volume 77, Issue 1, Pages 34-45Publisher
SAGE PUBLICATIONS INC
DOI: 10.1177/1077558718771123
Keywords
Medicaid; cancer; screening; managed care; physician payment
Funding
- National Institutes of Health [R01CA178980]
- National Cancer Institute
- (Office of Behavioral and Social Sciences Research)
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Medicaid-insured women have low rates of cancer screening. There are multiple policy levers that may influence access to preventive services such as screening, including physician payment and managed care. We examine the relationship between each of these factors and breast and cervical cancer screening among nonelderly nondisabled adult Medicaid enrollees. We combine individual-level data on Medicaid enrollment, demographics, and use of screening services from the Medicaid Analytic eXtract files with data on states' Medicaid-to-Medicare fee ratios and estimate their impact on screening services. Higher physician fees are associated with greater screening for comprehensive managed care enrollees; for enrollees in fee-for-service Medicaid, the findings are mixed. Patient participation in primary care case management is a significant moderator of the relationship between physician fees and the rate of screening, as interactions between enrollee primary care case management status and the Medicaid fee ratio are consistently positive across models of screening.
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