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Payments to Physicians Under Medicare and Medicaid

Ira L. Burney; George J. Schieber, PhD; Martha O. Blaxall, PhD; Jon R. Gabel, MS

JAMA. 1978;240(13):1368-1371.

Abstract
To study geographic differences in physician fees recognized by the Medicare and Medicaid programs, we analyzed physician reimbursement rates at the national, regional, state, and county levels. The results indicate that nationally, Medicaid specialist fees are 77% of Medicare specialist fees. Medicare specialist fees in metropolitan areas are 23% higher than those in nonmetropolitan areas, but there are no differences under Medicaid. State Medicare specialist fees varied from 73% to 132% of the national Medicare average, while Medicaid specialist fees ranged from 49% to 179% of the national Medicaid average. State Medicaid fees for specialists ranged from 39% to 100% of Medicare specialist fees. These results indicate that under national health insurance, fees set at national or statewide levels could have notable effects on physician renumeration in some localities.

(JAMA 240:1368-1371, 1978)

Author Affiliations
From the Office of Policy, Planning, and Research, Health Care Financing Administration, Department of Health, Education, and Welfare, Washington, DC.

Footnotes
The views expressed in this report are those of the authors and do not necessarily represent those of the Department of Health, Education, and Welfare.

Reprint requests to Health Care Financing Administration, Office of Policy, Planning, and Research, Room 5421, Department of Health, Education, and Welfare South Bldg, 330 C St SW, Washington, DC 20201 (Mr Burney).

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