Primary care physicians' views on access and health care reform: the situation in North Carolina.
BACKGROUND
This cross-sectional study assessed physicians' satisfaction with the current insurance-based reimbursement system and preferences for the two most frequently discussed health care reform proposals, and estimated the association between demographic and practice characteristics and attitudes toward health policy issues and reform plans.


METHODS
A random sample of 300 physicians was drawn from state licensure files of general practitioners, family physicians, and pediatricians practicing in North Carolina. All sample physicians were sent a schematic outline of the two major health reform alternatives and a 1-page self-administered questionnaire to determine their attitudes toward the current health care system and their preferences for health reform alternatives.


RESULTS
Sixty-nine percent of physicians responded to the survey. The responses indicated dissatisfaction with the current system and strong beliefs that access to care is inadequate in this diverse state with a large poor and rural population. Nearly one third of the physicians reported having insufficient information to choose between plans. Among physicians expressing a preference, 37% preferred managed competition, 38% preferred continuing the current system, and 25% preferred a single-payer system.


CONCLUSIONS
A uniform opinion about health care policy is a thing of the past for American medicine. Because terms used in the health reform debate (especially "managed competition") are ambiguous and set in the context of an increasingly diverse medical profession, no single direction of health reform (much less a specific plan) secures widespread understanding or support from a large proportion of physicians. None of the plans will please all of the doctors all of the time.
Millard
P S
PS
Department of Family Medicine, University of North Carolina at Chapel Hill 27599-7590.
Konrad
T R
TR
Goldstein
A
A
Stein
J
J
D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D018166:Health Care Reform; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D010821:Physicians, Family; D011795:Surveys and Questionnaires