title: Managed care, primary care, and the patient-practitioner relationship.
abstract: OBJECTIVE
  This study examines how specific attributes of managed health plans influence patients' relationships with their primary care practitioners (PCPs) and determines whether these effects are mediated by access to, continuity with, or perceived choice of PCPs.
  
  
  METHODS
  The data source was the nationally representative 1996/97 Community Tracking Study Household Survey (cumulative response rate 65%). The study population (N = 19,415) was composed of 18- to 64-year-old adults whose most recent visit in the past 12 months was made to their primary care delivery site.
  
  
  METHODS
  Patients' ratings of their interpersonal relationships with their PCPs as measured by a 7-item scale.
  
  
  RESULTS
  Gatekeeping arrangements that require patients to select a primary care physician or obtain authorization for specialty referrals were associated with lower ratings of the patient-PCP relationship. Health plan use of a provider network had no effect on the patient-PCP scale score. Although there were no significant differences across any insurance payer categories, uninsured adults rated their relationships with PCPs as significantly poorer than did their insured counterparts. Shorter office waits, having a specific clinician at the primary care site, better perceived choice of PCPs, and a longer duration of relationship with the primary care practitioner were associated with higher ratings of the patient-PCP relationship. Perceived choice of primary care practitioners, but not access to or continuity with PCPs, attenuated some of the negative effects of gatekeeping arrangements on patients' relationships with their primary care practitioners.
  
  
  CONCLUSIONS
  Managed health plans that loosen restrictions on provider choice, relax gatekeeping arrangements, or promote access to and continuity with PCPs, are likely to experience higher patient satisfaction with their primary care practitioner relationships. Lack of health insurance impedes the development of patients' relationships with their primary care practitioners.
authors.affiliation: Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Md 21205, USA. cforrest@jhsph.edu
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Forrest
authors.forename: Leiyu
authors.initials: L
authors.lastname: Shi
authors.forename: Sarah
authors.initials: S
authors.lastname: von Schrader
authors.forename: Judy
authors.initials: J
authors.lastname: Ng
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D020793:Gatekeeping / Q000458:organization & administration; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000458:organization & administration; D006801:Humans; D016014:Linear Models; D008297:Male; D008329:Managed Care Programs / Q000191:economics / Q000592:standards*; D008875:Middle Aged; D015999:Multivariate Analysis; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000191:economics / Q000592:standards*; D011787:Quality of Health Care; D014481:United States