The objective of this study is to use data from the National Survey of Children with Special Health Care Needs (NS-CSHCN) to test whether Medicaid physician fees are correlated with access to health services and adequacy of insurance coverage among CSHCN. We start with a difference-in-differences method, comparing the effects of Medicaid physician fees on outcomes of publicly-insured children in states that raised fees vs. in states that did not. As our preferred specification, we then estimate a triple difference model using privately-insured children as the comparison group. Our findings indicate that raising the Medicaid primary care fee level close to at least 90 percent of the Medicare level reduces the likelihood that publicly-insured CSHCN lack a usual source of care in a doctor’s office by about 15 percent. Fee increases are associated with improved access to specialty doctor care and large improvements in caregivers’ satisfaction with the adequacy of health insurance coverage among publicly-insured CSHCN. Results for some other access measures, such as global measures of having difficulties and delays accessing services, were mixed.

本研究的目的是使用来自全国有特殊医疗保健需求儿童调查 (NS-CSHCN) 的数据来测试医疗补助医生费用是否与 CSHCN 中获得医疗服务和保险覆盖范围的充分性相关。我们从差异中的差异方法开始，比较医疗补助医生费用对提高费用的州与未提高费用的州的公共保险儿童结果的影响。作为我们的首选规范，我们然后使用私人保险儿童作为对照组来估计三重差异模型。我们的研究结果表明，将 Medicaid 初级保健费用水平提高到接近 Medicare 水平的至少 90% 可以将公共保险的 CSHCN 在医生办公室缺乏常规护理来源的可能性降低约 15%。费用增加与获得专科医生护理的机会增加以及护理人员对公共保险 CSHCN 中健康保险覆盖范围的充分性的满意度大幅提高有关。其他一些获取措施的结果好坏参半，例如在获取服务时遇到困难和延迟的全球措施。