Impact of Medicare payment reductions on access to surgical services.
OBJECTIVE
This study evaluates the impact of surgical fee reductions under Medicare on the utilization of surgical services.


METHODS
Medicare physician claims data were obtained from 11 states for a five-year time period (1985-1989).


METHODS
Under OBRA-87, Medicare reduced payments for 11 surgical procedures. A fixed effects regression method was used to determine the impact of these payment reductions on access to care for potentially vulnerable Medicare beneficiaries: joint Medicaid-eligibles, blacks, and the very old.


METHODS
Medicare claims and enrollment data were used to construct a cross-section time-series of population-based surgical rates from 1985 through 1989.


RESULTS
Reductions in surgical fees led to small but significant increases in use for three procedures, small decreases in use for two procedures, and no impact on the remaining six procedures. There was little evidence that access to surgery was impaired for potentially vulnerable enrollees; in fact, declining fees often led to greater rates of increases for some subgroups.


CONCLUSIONS
Our results suggest that volume responses by surgeons to payment changes under the Medicare Fee Schedule may be smaller than HCFA's original estimates. Nevertheless, both access and quality of care should continue to be closely monitored.
Center for Health Economics Research, Waltham, MA 02154, USA.
J B
JB
Mitchell
J
J
Cromwell
D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D005245:Fee Schedules / Q000331:legislation & jurisprudence*; D006297:Health Services Accessibility / Q000191:economics* / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data; D006302:Health Services Research; D006801:Humans; D016345:Medicare Part B / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D012044:Regression Analysis; D012424:Rural Population / Q000706:statistics & numerical data; D013043:Specialties, Surgical / Q000191:economics* / Q000706:statistics & numerical data; D013514:Surgical Procedures, Operative / Q000191:economics / Q000706:statistics & numerical data*; D014481:United States