title: Physician satisfaction with Medicaid managed care: the Missouri experience.
abstract: BACKGROUND
  Medicaid managed care is important to health reform at the state level. However, little is known about physician satisfaction with these programs. We sought to measure this satisfaction in Missouri and determine its predictors.
  
  
  METHODS
  We surveyed a random sample of primary care physicians participating in Medicaid managed care (n = 670) or traditional Medicaid (n = 670). Primary outcomes measured were physicians' satisfaction Medicaid managed care, traditional Medicaid and commercial managed care. Satisfaction was measured on a 5-point Likert-type scale.
  
  
  RESULTS
  The response rate was 52%. Physicians participating in Medicaid managed care were less likely to be satisfied or very satisfied with Medicaid managed care (28.6%) than with commercial managed care (40%) or their previous experience with traditional Medicaid (39.7%). Among physicians participating in traditional Medicaid, 29.8% were satisfied or very satisfied with traditional Medicaid. Physicians participating in Medicaid managed care were less satisfied with clinical autonomy under that system in comparison with their previous experience with traditional Medicaid (relative difference = 10.8%, P =.001). In multiple linear regression analyses, clinical autonomy (R2 = 0.40) was a strong predictor of overall satisfaction with Medicaid managed care.
  
  
  CONCLUSIONS
  Enhancing physicians' clinical autonomy may result in improved satisfaction with Medicaid managed care. State Medicaid agencies should include physician satisfaction as a measure of Medicaid managed care plans' quality.
authors.affiliation: Department of Family Medicine, University of Virginia, Charlottesville, USA. Jgazewood@virginia.edu
authors.forename: J D
authors.initials: JD
authors.lastname: Gazewood
authors.forename: D R
authors.initials: DR
authors.lastname: Longo
authors.forename: R
authors.initials: R
authors.lastname: Madsen
mesh_terms: D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D005163:Factor Analysis, Statistical; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000458:organization & administration*; D008484:Medicaid / Q000458:organization & administration*; D008875:Middle Aged; D008923:Missouri; D010821:Physicians, Family / Q000458:organization & administration / Q000523:psychology*; D017009:Professional Autonomy; D011787:Quality of Health Care; D011795:Surveys and Questionnaires; D014481:United States