title: Impact of managed care on healthcare delivery practices: the perception of healthcare administrators and clinical practitioners.
abstract: Managed care has introduced changes, such as cost effectiveness, access to care, and quality of care, to many components of the U.S. healthcare delivery system. These changes have affected how healthcare administrators and clinical practitioners perceive the impact of managed care on healthcare delivery practices. A survey was initiated to explore whether the perceptions of administrators differed from those of practitioners and to discover which organizational variables could explain the difference. A descriptive, cross-sectional survey design was used for the target population of administrators and practitioners in high, moderate, and low managed-care-penetration markets. Two investigator-developed instruments--the Managed Care Perceptions Inventory (MCPI) and the MCPI-Demographic--and an intact centralization of decision-making assessment subscale were used for data collection. Administrators had a statistically significant, more positive perception of the impact of managed care on healthcare delivery than did practitioners. When the distinction between administrator and practitioner was not used as a grouping factor, managed care market penetration, nonprofit status, and years in current employment position were factors that had statistically significant associations with a more positive perception of managed care. Based on these findings, both administrators and practitioners have a role in maintaining awareness regarding their perceptions and should work collaboratively to address issues of concern. Similarly, promoting trust and commitment at the organizational level is important. Recommendations for further research are also provided.
authors.affiliation: VHA Inc., Irving, Texas, USA. MTIETZE@vha.com
authors.forename: Mari F
authors.initials: MF
authors.lastname: Tietze
mesh_terms: D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D003625:Data Collection; D003659:Decision Making, Organizational; D003695:Delivery of Health Care / Q000639:trends*; D006270:Health Facility Administrators / Q000523:psychology*; D006801:Humans; D008329:Managed Care Programs / Q000458:organization & administration*; D009718:Nurse Administrators / Q000523:psychology*; D008486:Physician Executives / Q000523:psychology*; D014589:Utah