ABSTRACT
BACKGROUND AND OBJECTIVES: Medicaid payment for healthcare services traditionally reimburses less than Medicare and commercial insurance. This disparity in reimbursement seems to be an important driver of limited access to care among Medicaid beneficiaries. This study seeks to examine the degree of variation in Medicaid and Medicare reimbursement for the most common neurosurgical current procedural terminology codes and determine its potential impact on provider accessibility. METHODS: In this cross-sectional study, maximum allowed physician reimbursement fees for 20 common neurosurgical codes reported in the literature were obtained from the 2022 Medicare Physician Fee Schedule and individual state Medicaid Fee-for-Service Schedules. The Medicaid-Medicare Index (MMI), which measures Medicaid reimbursement as a fraction of Medicare allowed amounts, was calculated for each procedure across 49 states and the District of Columbia. Lower MMI indicates a greater disparity, or "discount," between Medicaid and Medicare reimbursement. The proportion of providers accepting new Medicaid patients and total Medicaid enrollment were compared across states as a function of MMI. RESULTS: The average national MMI was 0.79, with a range of 0.37 in NY/NJ to 1.43 in NE. Maximum allowed amounts for Medicare reimbursement (coefficient of variation = 0.09) were less variable than those for Medicaid (coefficient of variation = 0.26, P < .01). The largest absolute disparity was observed for intracranial aneurysm clipping in NY, where the maximum Medicaid reimbursement is $3496.52 less than that of Medicare. Higher MMI was associated with a significantly larger proportion of providers accepting new Medicaid patients (R2 = 0.43, P < .01). Moreover, MMI varied inversely with the number of Medicaid beneficiaries (R2 = 0.12, P = .01). CONCLUSION: Medicaid reimbursement varies between states reflecting the disparate methods of fee schedule calculation. Lower reimbursement is associated with more limited provider enrollment, especially in states with a greater number of beneficiaries.
ABSTRACT
INTRODUCTION: Low health literacy contributes to health disparities. We sought to develop and evaluate a remotely administered tool to measure health literacy in health disparate populations. The basic research design involved asking the remotely administered questions in conjunction with an existing and valid measure of health literacy, the S-TOFHLA, to a non-representative convenience sample of individuals drawn from lower income communities. The measures of the remotely administered questions were then correlated with the results of the S-TOFHLA to determine if there was a connection between the two measures. We found a statistically significant correlation between a single question in the remotely administered survey and the validated S-TOFHLA measure. This research supports previous work that points to the importance of just a single remotely administered question in terms of correspondence with the S-TOFHLA. OBJECTIVE: Develop a questionnaire that can be remotely administered to check for Health Literacy. METHODS: Correlation analysis is conducted between various questions and S-TOFHLA scores to determine criterion validity. RESULTS: A single question, "How confident are you in filling out medical forms by yourself?" outperforms other measures in correlating with the S-TOFHLA scores. CONCLUSIONS: Further assessment of the confidence question both in isolation and in conjunction with other literacy identifiers should be conducted. Also, this question should be tested against other measures of health literacy beyond the S-TOFHLA.
ABSTRACT
Expanding access is often seen as a panacea for health problems. Although access is a necessary step, it is also important that policy analysts do not fail to consider postaccess issues. Increased access to health is often assumed to be synonymous with improved health outcomes; however, just because access exists does not mean (1) that everyone will take advantage of access to resources or (2) that those taking advantage of access will necessarily see improved outcomes. This article focuses on three aspects of health policy, (1) the types of postaccess issues that exist, (2) the "if you build it, they will come" syndrome, and (3) updating the Anderson/Aday model of health care access to better theoretically understand postaccess issues.
