MEDI-CAL: Low Reimbursement Rates Scare Off Pediatricians
As Medi-Cal pays some of the lowest reimbursement rates in the country, many California children's doctors have begun to limit their participation in the program, leading to long waits for children who need care, the Los Angeles Times reports. Although there is no definite number on the pediatric-physician shortage, "the impact is being felt at the academic medical centers and children's hospitals that accept patients regardless of their health coverage." Dr. Stuart Siegel, head of the pediatric hematology and oncology department at Childrens Hospital Los Angeles, said, "If you get more and more patients and no additional staff, you get delays in diagnostic studies, medical attention, [and] surgical attention." Those delays are not limited only to children in the Medi-Cal program.
The doctor shortage also has increased the Medi-Cal load for those hospitals that serve uninsured patients -- resulting in revenues that cannot cover the costs of care nor the costs of hiring the best doctors. Siegel added, "Here's California, one of the richest states, with the biggest population, and we are putting ourselves in the position of having a much inferior medical system." Recruiting and retaining doctors in a state with a high cost of living and low reimbursement rates has been difficult. Dr. Duncan Phillips, a former California doctor who has since moved to North Carolina, said that "practicing medicine in California is probably more difficult than any other state." The problem seems to encompass more than just Medi-Cal recipients. Dr. William Byrne, medical director of Children's Hospital Oakland, said, "One of the things it's hard to convince people is we're not just talking about access for poor kids. We're talking about access for everybody's kids. You may have the greatest insurance in the world, but there will not be a subspecialist available to see you."
While Medi-Cal officials have acknowledged that reimbursement rates are low, they contend that "health care is competing for limited dollars in a state with millions of poor residents." Budgetary restrictions also have hampered reimbursement increases. Stan Rosenstein, a state health department official who oversees Medi-Cal, said, "There were a significant number of years where the economy was bad, and there was no sufficient budgetary money to provide rate increases. We've taken steps to improve that" (Allen, 3/13).