Access to primary care for medicare beneficiaries

OBJECTIVES: To determine the acceptance rate of new Medicare patients by all primary care physicians. Among primary care physicians accepting new patients, to determine whether demographic and geographic factors are associated with the likelihood of accepting new Medicare patients. DESIGN: Cross-sectional. SETTING: Primary care physicians drawn from a national sample. PARTICIPANTS: Eight hundred forty-eight primary care physicians. MEASUREMENTS: Percentage of physicians accepting, not accepting, or conditionally accepting new Medicare patients. RESULTS: Of the 848 primary care physicians contacted, only 58% unconditionally accepted all new Medicare patients; 20% accepted new patients but restricted new Medicare patients using policies of nonacceptance or conditional acceptance. Of the 665 physicians accepting new patients, those in the south and west were more likely not to accept new Medicare patients than those in the northeast, with multivariable odds ratios (ORs) of 2.79 (95% confidence interval (CI)=1.34-5.78) and 3.14 (95% CI=1.35-7.33), respectively. Similarly, family physicians were more likely than internists not to accept new Medicare patients (OR=2.36, 95% CI=1.39-3.99). Primary care physicians in the Midwest were more likely to conditionally accept new Medicare patients than those in the northeast (OR=4.84, 95% CI=1.32-17.76), and primary care physicians in metropolitan areas with a population less than 100,000 were more likely to conditionally accept new Medicare patients than those in areas with a population greater than 100,000 (OR=2.39, 95% CI=1.18-4.84). CONCLUSION: Medicare beneficiaries' access to primary care is limited and varies significantly by region, population size, and type of provider.