Physicians' perceptions of managed care: a structural equation model assessment of key dimensions.
OBJECTIVE
To assess the interrelationship of physicians' own interest with that of the methods and the anticipated benefits of managed care, the authors developed a new instrument to assess physician's perception of job satisfaction, risk, need to adapt their practice behavior, quality of care, cost of care, and access under managed care.


METHODS
One hundred sixty-one attending physicians of an urban public hospital in a metropolitan area with low to moderate managed care penetration participated. A 24-item questionnaire with good psychometric properties was developed based on literature reviews, qualitative interviews with the key informants, and focus group discussion among a group of selected physician representatives. Confirmatory factory analysis and structural equation models were applied.


RESULTS
The study reveals that when physicians perceived that high job satisfaction would ensue, they also perceived that quality and access to care would improve under managed care. Physician's perception of the need to modify their practice behavior was associated with a perception of increasing the cost of care. Risk sharing, from the physician's perspective, did not translate to cost savings as expected by managed care organizations, and only resulted in a fractional improvement on a perception of quality and access of care.


CONCLUSIONS
Although this study reports the perceptions of a small group of physicians from a single hospital, the data suggest that increasing quality and decreasing cost may be included in the same equation, if physician job satisfaction also is included through organizational support and user-friendly work environment.
Conway
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Department of Medicine, Cook County Hospital, Chicago, IL 60612, USA.
Hu
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Daugherty
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D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D005163:Factor Analysis, Statistical; D005260:Female; D006279:Health Maintenance Organizations; D006297:Health Services Accessibility; D006779:Hospitals, Public; D006786:Hospitals, Urban; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008329:Managed Care Programs / Q000592:standards / Q000706:statistics & numerical data*; D008505:Medical Staff, Hospital / Q000523:psychology* / Q000706:statistics & numerical data; D008875:Middle Aged; D015233:Models, Statistical; D011594:Psychometrics; D011787:Quality of Health Care; D011795:Surveys and Questionnaires; D014481:United States