Medicaid and Medicare reimbursement versus cost of care

Medicaid reimburses doctors between 60 percent and 80 percent of the cost of care. As the rolls of beneficiaries swell, doctors may limit more strictly the number of patients they will accept. Some may have to close their practices.

Medicare patients, too, may have a harder time finding physicians. The nation's health insurance program for those age 65 and older is poised to cut physician payments by more than 15 percent in the next year.

"A crisis is definitely not out of the questions," said Medical University of South Carolina economist Rich Lindrooth. Hit hardest will be small practices, with no one to share the burden of write-offs and overhead.

Compounding the crisis is the expected shortage of primary care doctors. As medical students watch reimbursement drop and Medicare and Medicaid rolls grow, fewer will choose the path of family practice.

Read more in tomorrow's editions of The Post and Courier.