What do managed care plans do to affect care? Results from a survey of physicians.
Little is known about physicians' exposure to managed care techniques that affect clinical practice. In 1995, we conducted a survey of 2,003 U.S. physicians asking them about their share of patients subject to a variety of managed care techniques. Nationally, 24% of physicians received some form of capitation payment for their patients. The two most widely used techniques were utilization review (UR), applied to an average of 59% of patients, and discounted fees, applied to an average of 38% of patients. Although UR was common, ultimate denial rates of coverage were very low: at most 3% for the types of care studied. Use of managed care techniques varied more within states than between states. Conventional measures of HMO market penetration revealed little about how managed care affects physicians.
Remler
D K
DK
Institute for Health Services Research, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA 70112-2699, USA.
Donelan
K
K
Blendon
R J
RJ
Lundberg
G D
GD
Leape
L L
LL
Calkins
D R
DR
Binns
K
K
Newhouse
J P
JP
D002204:Capitation Fee / Q000706:statistics & numerical data*; D003625:Data Collection; D005251:Fees, Medical; D006801:Humans; D019458:Insurance Coverage; D008329:Managed Care Programs / Q000191:economics / Q000458:organization & administration* / Q000706:statistics & numerical data; D005791:Patient Care / Q000191:economics / Q000592:standards; D010820:Physicians / Q000191:economics* / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D016079:Refusal to Treat; D014481:United States; D014600:Utilization Review / Q000706:statistics & numerical data*