Pediatricians Participating in Medicaid

To the Editor. —In their article on factors associated with pediatricians' participation in Medicaid in North Carolina, Margolis et al1concluded that higher reimbursement rates exert only modest effects on participation. They believe that a strategy aimed at improving pediatricians' knowledge of the program and at enlisting the support of community physicians would be more effective since participation appears to be strongly influenced by a pediatrician's familiarity with and attitude toward Medicaid. They also conclude that pediatricians who practice in smaller communities or areas with lower physician-to-patient ratios are more likely to accept Medicaid patients. In an effort to retain obstetricians' participation, the Maryland Medicaid program increased payments for deliveries from $265 to $550 in March and then to $795 in July 1986. The rationale was to eliminate the disparity in payment between Medicaid and private insurers and thereby to reduce financial disincentives toward participation. Recently, we evaluated the