title: A comparison of ambulatory services for patients with managed care and fee-for-service insurance.
abstract: OBJECTIVE
  To determine whether family physicians provide different ambulatory care to patients with health insurance from managed care organization (MCO) versus fee-for-service (FFS) plans.
  
  
  METHODS
  Multimethod cross-sectional observational study.
  
  
  METHODS
  A total of 4454 patients made office visits to 138 family physicians in northeastern Ohio. Direct observation with the Davis Observation Code and a structured checklist were used to assess the process of care. Patient satisfaction was measured with the Medical Outcomes Study 9-Item Visit Rating Form.
  
  
  RESULTS
  Among 1588 patients with MCO insurance and 876 with FFS insurance, no differences were noted in the number of visits per year, length of visits, percentage of visits for well care, or the percentage of visits in which medicines were prescribed in analyses controlling for patient mix. Visits by patients with MCO insurance were more likely to involve referrals to another physician than visits by patients with FFS insurance. Patient satisfaction and time use during visits were comparable for the 2 groups.
  
  
  CONCLUSIONS
  Managed care insurance appears to increase involvement of the primary care provider in the referral process. However, in a healthcare market with moderate managed care penetration in which the same physicians see patients with different types of insurance, the process of care is affected little by type of insurance coverage.
authors.affiliation: Department of Family Medicine, Ireland Cancer Center, Case Western Reserve University, Cleveland, OH 44106-4950, USA. gek@po.cwru.edu
authors.forename: George E
authors.initials: GE
authors.lastname: Kikano
authors.forename: Clint W
authors.initials: CW
authors.lastname: Snyder
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Callahan
authors.forename: Meredith A
authors.initials: MA
authors.lastname: Goodwin
authors.forename: Kurt C
authors.initials: KC
authors.lastname: Stange
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000458:organization & administration*; D003430:Cross-Sectional Studies; D005194:Family Practice / Q000458:organization & administration*; D018588:Fee-for-Service Plans; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D008329:Managed Care Programs; D009819:Office Visits; D009820:Ohio; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D017064:Process Assessment, Health Care; D014600:Utilization Review