Obstetricians' receptiveness to teen prenatal patients who are Medicaid recipients
Gifford, B.
Health Services Research 32(3): 265-282
1997
ISSN/ISBN: 0017-9124 PMID: 9240280 Document Number: 269733
A survey of 221 obstetricians and gynecologists from Chicago, Illinois, sought to obtain an accurate estimate of physician participation in the Medicaid program. Female graduate students posing as the older sister of a pregnant teenager called physicians' offices seeking information on care provided during a first prenatal appointment. Overall, 81 (36.7%) of these physicians accepted new Medicaid patients for prenatal care. The participation rate was 44.1% among physicians with offices in Chicago (52.5% among those practicing in Chicago's poorest neighborhoods) compared with 24.7% among those with offices in the suburbs. Over 95% of receptionists categorized as "difficult" in their phone conversations with researchers worked for physicians who would not accept new Medicaid patients. Logistic regression analysis identified the following factors as significantly associated with Medicaid acceptance: first appointment duration under 20 minutes, appointment availability within 1 week, two or more tests administered, and high reception helpfulness. These findings suggest that attitudinal and organizational barriers further compound the low accessibility of office-based physician care to prenatal Medicaid patients. Physicians appear to manage their practices to attract certain patient types, and these recruitment practices are reflected in differing patterns of Medicaid participation.