 | The 131st Annual Meeting (November 15-19, 2003) of APHA |
|
| The 131st Annual Meeting (November 15-19, 2003) of APHA |
Monica L. Wendel, MA, MPH1, Michael R.J. Felix2, James N Burdine, Dr PH1, Julie Ann Parrish, MA3, Coleman Chandler, MPH3, Jay Jezierski, MPH1, Sanu Somachandran, MPH1, and Rachel Annette Summers3. (1) Community Health Development Program, School of Rural Public Health, Texas A&M University, 1103 University Drive, Suite 100, College Station, TX 77840, 979-458-0937, mlwendel@srph.tamushsc.edu, (2) Michael Felix and Associates, Walburt Ave, Allentown, PA 77802, (3) School of Rural Public Health, Texas A&M University System, 1103 University Drive, Suite 100, College Station, TX 77840
The health service financing picture has evolved dramatically in the Rio Grande Valley (RGV) over the past 20 years. In the 1980s, many service providers refused to accept Medicaid. This attitude is similar in other areas of the country today, where providers seek to minimize the number of Medicaid and Medicare patients in their case mix because they get more money for treating the privately insured. However, when examining the current state of the health care delivery system in the RGV, the role of Medicaid has totally reversed.
Data indicate that there are about 1,600 residents per primary care provider in the RGV. Of those, approximately one-third are uninsured and another third covered by Medicaid. Service providers in this region report, however, that Medicaid patients actually constitute about 80 percent of their case mix. In twenty years, the system has gone from fighting over who has to serve the Medicaid patients to fighting over who gets to serve the Medicaid patients. This phenomenon has led to strained relationships and politics over health services in the region, and any new provider coming into the community is seen as a potential threat.
The change in the role of Medicaid in the region has serious policy implications. Federal and state policies are developed under the assumption that Medicaid patients make up a small portion of a provider's case mix. Efforts must be made to examine communities where this assumption is false and to create policies that address the issues arising from this phenomenon.
Learning Objectives:
Keywords: Medicare/Medicaid, Policy/Policy Development
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.