New Managed Care Study Results from Oregon Health & Science University (OHSU) Described (‘ghost’ Physicians: More Than One-quarter of Physicians Enrolled In Medicaid Delivered No Care To Beneficiaries In 2021): Managed Care

2026 MAR 17 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- Investigators publish new report on Managed Care. According to news reporting originating in Portland, Oregon, by NewsRx journalists, research stated, “Concerns about low physician participation in Medicaid have long motivated policy reforms, but the extent to which enrolled physicians actually care for Medicaid patients remains unclear. To assess patterns of Medicaid participation among physicians, we linked physician enrollment files to Medicaid administrative claims from the period 2019-21, focusing on five physician specialties: cardiology, dermatology, ophthalmology, primary care, and psychiatry.”

Financial supporters for this research include NIH National Institute of Mental Health (NIMH), Office of the Administrator (NIH).

The news reporters obtained a quote from the research from Oregon Health & Science University (OHSU), “We examined the proportion of Medicaid-enrolled physicians with any claims activity and the volume of unique Medicaid patients and encounters per physician. We found that although 68-89 percent of physicians were enrolled in Medicaid, nearly 28 percent delivered no care to Medicaid beneficiaries in 2021. Participation in Medicaid varied widely by specialty: More than 40 percent of psychiatrists were ‘ghost’ physicians who saw no Medicaid enrollees in a given year, whereas primary care physicians were most likely to be high-volume ‘core’ participants. Although most physicians maintained stable participation over time, approximately one-fifth of ghost providers and one-third of ‘peripheral’ providers (those seeing 1-10 Medicaid enrollees per year) transitioned to a higher-engagement group between 2020 and 2021.”

According to the news reporters, the research concluded: “Taken together, our findings demonstrate that given relatively limited and variable Medicaid participation, targeted policy efforts-particularly in specialties such as psychiatry-may help strengthen physician engagement and reduce access gaps.”

This research has been peer-reviewed.

For more information on this research see: ‘ghost’ Physicians: More Than One-quarter of Physicians Enrolled In Medicaid Delivered No Care To Beneficiaries In 2021. Health Affairs, 2026;45(2):129-137. Health Affairs can be contacted at: Project Hope, 7500 Old Georgetown Rd, Ste 600, Bethesda, MD 20814-6133, USA.

Our news correspondents report that additional information may be obtained by contacting Jane M. Zhu, Oregon Health & Science University (OHSU), Portland, OR 97239, United States. Additional authors for this research include Kirbee A. Johnston, Kyle Hart, K. John McConnell and Daniel Polsky.

The direct object identifier (DOI) for that additional information is: https://doi.org/10.1377/hlthaff.2025.00703. This DOI is a link to an online electronic document that is either free or for purchase, and can be your direct source for a journal article and its citation.

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