
                         Roanoke Times
                 Copyright (c) 1995, Landmark Communications, Inc.

DATE: TUESDAY, April 2, 1991                   TAG: 9104020415
SECTION: NATIONAL/INTERNATIONAL                    PAGE: A1   EDITION: METRO 
SOURCE: The New York Times
DATELINE: WASHINGTON                                LENGTH: Medium

MEDICAID FEES ALMOST 1/3 LESS THAN MEDICARE

Medicaid, the health program for poor people, pays doctors much less than either Medicare or private health insurers for the same services, and as a result many doctors are refusing to take Medicaid patients, a federal advisory commission said Monday.

In a report to Congress, the panel, the Physician Payment Review Commission, said Medicaid pays doctors 69 percent of what Medicare pays, and an even smaller proportion of what private insurers pay.

Forty-four states have problems getting doctors to participate in Medicaid, and "low fees were cited as the most common factor in discouraging participation," the commission said.

Medicare, the federal health insurance program for 33 million elderly and disabled people, has a much stronger political constituency than Medicaid, a federal-state program for 27 million low-income Americans.

While doctors have often complained informally about the level of Medicaid payments, the study by the non-partisan commission is the most systematic attempt to date to measure the disparities.

Another reason for the disparity in doctors' fees under the programs is the the way the programs are financed. Medicare has its own trust funds, composed of payroll taxes, premiums and general revenues.

Medicaid, by contrast, depends almost entirely on general federal and state revenues.

The federal government decides how much to pay doctors under Medicare, and has historically guaranteed that physicians receive fees close to market rates.

But states have wide discretion in deciding how much to pay in doctors' fees under Medicaid. State Medicaid agencies set the fees.

States often fail to update doctors' fees to take account of inflation. In some states, Medicaid pays less than it costs for doctors to perform certain services.

The commission said Medicaid recipients are less likely than other people to have a continuing relationship with a doctor, less likely to receive care in a private office and more likely to receive basic care in a hospital emergency room or clinic.

by CNB