l**n
发帖数: 60 | 1 出诊给9元！医师拒收Medi-Cal
柏克莱市外科医师卡普兰（Dr. Jerold Kaplan）去年到一名脚伤病人家里看诊。由于
是加州医疗补助计画（Medi-Cal）的病人，所以他向Medi-Cal开了90元的诊疗费。他以
为自己的收费已经很便宜，但是Medi-Cal只给他8.96元。
去年，卡普兰还出诊看了一个小儿麻痺症病人，Medi-Cal也只付他13.44元，事后还向
他解释，因为他的收费单寄得太晚，所以将收费减半。也就是说，就算全额也只不过27
元。
加州正全力迎接联邦健保改革法的到来，并且将Medi-Cal扩大，纳入150万无健保人士
，另外还要吸收90万名「健康家庭计画」（Healthy Families ）的儿童，因为原来为
贫穷家庭儿童提供健保的「健康家庭」已经取消。
但是，Medi-Cal付给医师的医疗费太低，让专家担心到2014年新健保法推行时，根本没
有医师愿意为Medi-Cal病人看病。
卡普兰医师说：「Medi-Cal给医师的极低费用，已成为笑话，所以很多医师根本不感兴
趣。」
有770万病人的Medi-Cal是联邦医疗补助计画（Medicaid）的加州版本，预计于2014年
增加上述240万人后，等于扩张30%，医师不足的情况将进一步恶化。
目前Medi-Cal付给医师的费用，在全国50个州排第47名。如果州政府的赤字问题得不到
解决，还可能进一步削减。
2011年的一项调查发现，23%的Medi-Cal病人说很难找到家庭医师；34%则说很难找到专
科医师。找不到医师的病人只好看急诊，造成急诊室拥挤。
南湾洛斯盖图的耳鼻喉科医师路易斯（Dr. William Lewis）说，他在诊所看病，Medi-
Cal只给他15至20元，联邦医疗保险计画（Medicare）给他50元，私人健保公司则给60
元至70元。他说，Medi-Cal给的钱难以让医师维持下去。
Medi-Cal compensation inadequate, docs say, as enrollment boom looms
By SANDY KLEFFMAN/MediaNews Group
When Dr. Jerold Kaplan made a home visit last year to a man with a foot
wound, he billed Medi-Cal -- the state's health care program for the poor
and disabled -- what he thought was a modest $90.
His payment: $8.96.
The Berkeley wound surgeon received a bit more for his home visit to a
quadriplegic last year: $13.44.
Medi-Cal told him it cut both payments in half because of late paperwork.
But even at the full rate, he would have received no more than $27 for a
house call -- barely enough to cover gas.
As California gears up for a major expansion of Medi-Cal under national
health reform, such compensation is leading to a critical concern: Will
enough physicians be willing to see the influx of new patients?
Many doctors now refuse to accept Medi-Cal patients or sharply limit the
number they see because of what they describe as extremely low reimbursement
rates. As a result, patients report difficulty getting timely care, a
problem the expansion could worsen.
"Medi-Cal has gotten so ridiculous in its reimbursement there are a lot of
doctors that aren't interested in working for it," Kaplan said.
Now covering 7.7 million Californians, Medi-Cal is the state's version of
the federal Medicaid program.
It is expected to grow by 900,000 children with the state's recent
elimination of the Healthy Families program, which provided low-cost
insurance for children and teens. The state will enroll an additional 1.5
million or more adults when national health reforms take effect in 2014.
All told, Medi-Cal could balloon by 30 percent, financed largely by an
additional $9 billion a year in federal money beginning in 2014.
Many consumer advocates strongly support the expansion and argue that it
will greatly benefit the state by giving preventive care to those who are
uninsured, helping them avoid more serious -- and more costly -- illnesses.
"It's going to be a huge boon to not just the newly covered Californians,
but to our health care system as a whole," said Anthony Wright, executive
director of Health Access California. But Wright agreed work needs to be
done to make sure the program is ready.
California has one of the lowest Medicaid reimbursement rates in the nation,
ranking 47th of 50 states.
And it could drop further. In a budget move, state lawmakers last year
approved a 10 percent pay cut for Medi-Cal providers. But the cut is on hold
pending a ruling on a lawsuit doctors filed.
While patients generally laud the program, 23 percent of adults report
difficulty in finding a primary care doctor who will accept Medi-Cal, and 34
percent have had trouble finding a specialist, according to a 2011 survey
by the California HealthCare Foundation.
Medi-Cal pays Lewis $15 to $20 for an office visit, compared with the $50 he
gets from Medicare and $60 to $70 from a private insurer. The Medi-Cal
rates are so low, Lewis said, he doesn't bother billing for it because it's
not worth the hassle. He just eats the cost.
Lewis typically declines to see new Medi-Cal patients unless it is a follow-
up visit with someone he treated in a hospital emergency room.
"You cannot run a practice seeing Medi-Cal patients," he said. "You can't
pay your employees and pay for your overhead and keep your doors open."
Statistics on the number of physicians who accept Medi-Cal are hard to come
by. The state has nearly 80,000 doctors enrolled as Medi-Cal providers, a
number that has held fairly steady over the past five years, said Norman
Williams, spokesman for the state Department of Health Care Services.
But critics counter that many of those physicians see only a patient or two,
or have closed their practice to new Medi-Cal patients.
Under the national health reform law, Medi-Cal payments for primary care
doctors will rise to Medicare levels in 2013 and 2014, Williams noted. That
will mean a significant pay boost in California and should help ensure there
will be enough doctors to see patients, he said.
But the boost will not apply to specialists, and many primary care doctors
may be reluctant to accept new patients fearing the rates will drop back in
2015, said Dr. Ted Mazer, an officer with the California Medical Association
and a San Diego-based ear, nose and throat surgeon.
The state will monitor Medi-Cal patients' access to doctors, and if problems
develop, "we'll take immediate action," Williams said.
Some fear that the doctors, clinics and hospitals that see Medi-Cal patients
now will be inundated once the expansion occurs.
When San Mateo mom Macrina Mota's daughter injured her foot playing soccer
last year, the two spent 13 hours in an emergency room to treat a sprained
foot.
"They're just overbooked; they're overloaded," Mota said.
Other Medi-Cal recipients encounter different barriers. New mother De Jornae
Thomas, of Oakland, said having Medi-Cal has helped ensure that her 2-month
-old son, Josiah, has the medical attention he needs. But because Medi-Cal
requires her to pay a cost-sharing fee, she avoids checkups for herself.
"I haven't been to the doctor in awhile for myself, outside of my pregnancy,
" she said.
http://www.dailydemocrat.com/ci_21067258/medi-cal-compensation- | A*******s
发帖数: 9638 | 2 我们这里很多医生是不看medicaid病人的， 导致这些病人只能到ER去。
我看medicaid， 因为这一部分人很多有很重的病。 但有些病人就abuse这个系统，反
正不要钱，一点小事就要看， 到了预约的日子又不来了。
Obamacare的一个最根本的问题就是让government来管理medical service， 也就是增
加官僚机构。 只要在美国VA system工作过的就知道那是一个什么服务。
Government is no good.
27
【在 l**n 的大作中提到】
: 出诊给9元！医师拒收Medi-Cal
: 柏克莱市外科医师卡普兰（Dr. Jerold Kaplan）去年到一名脚伤病人家里看诊。由于
: 是加州医疗补助计画（Medi-Cal）的病人，所以他向Medi-Cal开了90元的诊疗费。他以
: 为自己的收费已经很便宜，但是Medi-Cal只给他8.96元。
: 去年，卡普兰还出诊看了一个小儿麻痺症病人，Medi-Cal也只付他13.44元，事后还向
: 他解释，因为他的收费单寄得太晚，所以将收费减半。也就是说，就算全额也只不过27
: 元。
: 加州正全力迎接联邦健保改革法的到来，并且将Medi-Cal扩大，纳入150万无健保人士
: ，另外还要吸收90万名「健康家庭计画」（Healthy Families ）的儿童，因为原来为
: 贫穷家庭儿童提供健保的「健康家庭」已经取消。
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