Look no further than the Illinois Medicaid program to understand why more physicians are not being lured into the primary-care profession.

Despite repeated calls by President Obama and members of Congress for people to have a medical home -- a primary-care physician -- those doctors usually receive low pay for what they do. Such doctors include family physicians, pediatricians and internists who are generally paid less than specialists but are key to keeping patients well and out of the more expensive hospital care setting.

Illinois is notorious for low payments from the Medicaid program for the poor. Payments are funded by state and federal taxes but administered by Illinois health officials.

Though payments can vary depending on the service provided, it's not uncommon for a physician to be paid $25 to $75 for a Medicaid patient's routine visit. That can be 20 percent to 30 percent less than what the Medicare health insurance for the elderly pays and less than half the $100 to $125 or more a private insurer would pay for the same service.

Medicare-driven compensation also rewards doctors who do procedures over those who diagnose illness and dispense prescriptions.

In 2005, for example, Medicare paid $89.64 for a half-hour visit to a primary-care doctor in Chicago, a Government Accountability Office report stated. It paid $422.90 to a gastroenterologist who spent about the same amount of time performing a colonoscopy in a private office. The colonoscopy, specialists point out, requires more equipment, specialized skills and higher malpractice premiums.


"Low reimbursement and pay are the driving reasons medical students are not choosing family medicine," said Dr. David Hagan, a family physician from Gibson City, Ill., who is first vice president of the Illinois Academy of Family Physicians.

Primary-care physicians say it's more than just paying doctors a fee when they come to the office -- they need incentives to cover their costs of coordinating follow-up care, including return visits to make sure a diabetic patient is taking medications or adhering to a wellness program.

Payments, these doctors say, should be performance-based so doctors are rewarded when they successfully manage their patients' care. "There really isn't any payment for quality," Hagan said.

In Illinois, where Obama once chaired the state Senate's Health and Human Services Committee when he represented Chicago's South Side, primary-care doctors were pleased his American Medical Association address included payment reform.

In his hourlong speech last week in Chicago, Obama said the fee-for-service system rewards "quantity of care rather than the quality of care," adding, "That pushes you, the doctor ... to order that extra MRI or EKG, even if it's not necessary."

Obama offered some ideas on improving reimbursement.

"We need to bundle payments so you aren't paid for every single treatment you offer a patient with a chronic condition like diabetes, but how well you treat the overall disease," Obama said. "We need to give doctors bonuses for good outcomes, so we're not promoting just more treatment but better care."

The Washington Post contributed to this report.