Managed Care

Doctors who feel pressured by insurers to reduce services are more apt to be dissatisfied with medical practice

Managed care plans typically use financial incentives to influence physicians to use fewer health resources. However, many doctors are not particularly satisfied with this arrangement, suggests a study supported in part by the Agency for Health Care Policy and Research (HS09196). Doctors who perceive moderate or strong incentives by managed care plans to reduce health services are more apt to be dissatisfied with the practice of medicine, feel they have less freedom to care for patients the way they would prefer, and feel they have less professional autonomy to practice good medicine.

Although financial incentives to reduce services are not widespread, there is a legitimate reason to be concerned about possible adverse effects on the quality of care, notes Jack Hadley, Ph.D., of Georgetown University Medical Center. Dr. Hadley and his colleagues conducted a 1997 telephone survey of 1,549 physicians located in 75 large metropolitan areas. About 15 percent of doctors surveyed perceived a moderate or strong incentive to reduce services; 70 percent reported a neutral incentive; and 15 percent reported an incentive to increase services. Compared with doctors with a neutral incentive, those who felt an incentive to reduce services were from 1.5 to 3.5 times more likely to be very dissatisfied with their practices and were 0.2 to 0.5 times as likely to report that their expectations regarding professional autonomy and ability to practice good quality medicine were met. They were also 0.2 to 0.6 times as likely to report having the freedom to care for patients the way they would like, such as sufficient time with patients, ability to hospitalize patients, ability to order tests and procedures, and ability to make referrals.

See "Perceived financial incentives, HMO market penetration, and physicians' practice styles and satisfaction," by Dr. Hadley, Jean M. Mitchell, Ph.D., Daniel P. Sulmasy, M.D., Ph.D., and M. Gregg Bloche, M.D., J.D., in the April 1999 Health Services Research 34(1), pp. 307-321.

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