Report from the front lines: rural Medicaid primary care providers as gatekeepers of rural health service networks.
This study of primary care practitioners in Louisiana's Medicaid managed care program, Community Care, focused on the program's implementation and perceived impact. PCPs were interviewed to assess their perceived responsibilities as gatekeepers and how well they believed the system facilitated or impeded their fulfillment of those responsibilities, to examine issues of access and quality, and to determine their knowledge and use of local referral networks. Findings indicate that although they appreciated the financial stability derived from having a larger patient base and understood their roles well, they were concerned with several facets of the program, including perceived limitations imposed on their medical decision making, an added burden of paperwork, and a lack of both downward and upward communication. They also believed the referral network of available providers for medical and social services to be more limited for their Medicaid patients than for their private patients. Policy implications are discussed.
Tulane University, USA.
A H
AH
Butcher
J C
JC
Szekely
D001291:Attitude of Health Personnel; D019058:Community Networks / Q000458:organization & administration; D019538:Health Care Surveys; D006801:Humans; D008145:Louisiana; D008329:Managed Care Programs / Q000458:organization & administration*; D008484:Medicaid / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D012017:Referral and Consultation; D019035:Rural Health Services / Q000458:organization & administration*; D014481:United States