Physicians as Mediators of Health Policy: Acceptance of Medicaid in the Context of Buprenorphine Treatment

• In Event: 368 - Section on Alcohol, Drugs, and Tobacco Refereed Roundtable Session and Business Meeting
  In Refereed Roundtable 60min: Table 03. The Labeling and Treatment of Opioid Users

Abstract

Medicaid improves access to care for individuals who are economically disadvantaged. However, physicians are free to decline Medicaid as a method of patient payment, which can reinforce health care disparities faced by this population. Previous research has documented that physicians are less likely to accept Medicaid relative to private insurance or cash payment, but few studies have examined Medicaid acceptance as a function of physician-level and state-level characteristics. The present study focuses on physicians’ acceptance of Medicaid for buprenorphine treatment, which is an evidence-based pharmacotherapy for treating opioid dependence. By integrating survey data collected from 808 physicians who prescribe buprenorphine with secondary data on state characteristics, this study estimates a multi-level model of Medicaid acceptance that includes physician-level measures and state characteristics. Only 53.5% of physicians accepted Medicaid for the payment of buprenorphine-related office visits. The multi-level model indicated that specialists in addiction and psychiatry were less likely to accept Medicaid, as were physicians who delivered buprenorphine in an individual medical practice. Perceived adequacy of Medicaid reimbursement was positively associated with accepting Medicaid for payment. Two state-level variables were negatively associated with Medicaid acceptance: (1) the percentage of African American residents in the state and (2) a measure of the difference between the percentage of residents who were poor and the percentage covered by Medicaid. These findings point to ongoing disparities in access to care faced by individuals who are insured by Medicaid as well as how state environments may reinforce such disparities by impacting physicians’ willingness to accept Medicaid.

Authors

• Hannah K. Knudsen, University of Kentucky

• Jamie L. Studts, University of Kentucky