Pediatricians Gradually Leaving Medicaid Plan

The number of pediatricians who see poor children under the Medicaid program is shrinking, causing the American Academy of Pediatrics to express concern about the quality of future care.

The federally funded study found the number of pediatricians participating in Medicaid has declined from 85% to 82% in the last five years.

In addition, 35% of the pediatricians have limited their Medicaid clientele to an average of no more than 15% of their patient load. In a few states such as California, more than half the doctors have set limits.

Academy officials said that despite the recent declines, the percentage of pediatricians participating in Medicaid remains higher than for other types of doctors. The study was done by the academy, which represents 27,000 pediatricians.

Reasons for Decline Asked to explain the decline, the doctors blamed an increasing amount of Medicaid paper work, delays in payment and reimbursement levels lower than their usual fees.

Another reason cited, however, is that doctors are competing more vigorously with each other for non-Medicare patients as the country enters a mini-baby boom.

Medicaid, begun in 1965, is the basic state-federal health care program for 23 million poor people in the United States. Participants go to the doctors and hospitals of their choice. Last year, states reimbursed the medical profession $15 billion and the federal government paid out $17 billion under Medicaid.

But beset by higher costs, the program is changing.

Twenty-five states now require the poor to pay a portion of their care. Fourteen states pay doctors a set fee regardless of services rendered. And some states, much to the dismay of the medical profession, require doctors to get authorization before hospitalizing Medicaid patients. Medicare officials are also trying to move more patients into health maintenance organizations where patients do not choose a doctor but see whoever is on duty.

The pediatricians’ group argues that if more doctors pull out of the program, Medicaid costs could rise as the poor go back to doing what they used to do--use hospital emergency rooms for routine health care.