Physician participation and nonparticipation in Medicaid managed care: the TennCare experience.
BACKGROUND
TennCare is a significant state health reform effort, channeling all Medicaid recipients into managed care. We examined physician attitudes about TennCare.


METHODS
In 1997, we surveyed a stratified random sample of Tennessee physicians using predominantly Likert-type scale questions. All physicians surveyed were involved in patient care and were selected from seven specialties: general practice, family practice, general internal medicine, obstetrics/gynecology, neurosurgery, general surgery, and pediatrics. We asked about participation, satisfaction, perceptions of quality, and appropriateness of care.


RESULTS
Major reasons for nonparticipation included bureaucracy and low compensation. Overall, dissatisfaction with TennCare was high (72% not at all or not very satisfied), relating to reimbursement issues and constraints on obtaining services, particularly pharmaceuticals. More physicians (45.9%) thought quality had declined under TennCare than believed it improved (12.6%).


CONCLUSIONS
Despite strong negative opinions about TennCare, physician participation is high (85.6%) because of a sense of professional responsibility.
Sloan
F A
FA
Center for Health Policy, Law and Management, Department of Economics, and Fuqua School of Business, Terry Sanford Institute of Public Policy, Duke University, Durham, NC 27708, USA.
Conover
C J
CJ
Rankin
P J
PJ
D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000458:organization & administration / Q000706:statistics & numerical data*; D008484:Medicaid / Q000706:statistics & numerical data*; D010820:Physicians / Q000706:statistics & numerical data; D011787:Quality of Health Care; D013714:Tennessee; D014481:United States