What Do Managed Care Plans Do to Affect Care? Results from a Survey of Physicians

Little is known about physicians' exposure to managed care techniques that affect clinical practice. In 1995, we conducted a survey of 2,003 U.S. physicians asking them about their share of patients subject to a variety of managed care techniques. Nationally, 24% of physicians received some for...

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Bibliographic Details
Published in:	Inquiry (Chicago) Vol. 34; no. 3; pp. 196 - 204
Main Authors:	Remler, Dahlia K., Donelan, Karen, Blendon, Robert J., Lundberg, George D., Leape, Lucian L., Calkins, David R., Binns, Katherine, Newhouse, Joseph P.
Format:	Journal Article
Language:	English
Published:	United States Finger Lakes Blue Cross and Blue Shield 01-10-1997 SAGE PUBLICATIONS, INC
Subjects:	Capitation Capitation Fee - statistics & numerical data Data Collection Effects Fees & charges Fees, Medical Health care delivery Health insurance Health maintenance organizations Health policy HMOs Humans Incentives Insurance Coverage Managed care Managed Care Programs - economics Managed Care Programs - organization & administration Managed Care Programs - utilization Market penetration Medical practice Medical referrals Medicare Monetary incentives Patient Care - economics Patient Care - standards Physicians Physicians - economics Physicians - statistics & numerical data PPOs Practice Guidelines as Topic Public health Refusal to Treat Regression analysis Salary Studies Surgeons United States Utilization review Utilization Review - statistics & numerical data Wages & salaries United States United States > US
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Summary:	Little is known about physicians' exposure to managed care techniques that affect clinical practice. In 1995, we conducted a survey of 2,003 U.S. physicians asking them about their share of patients subject to a variety of managed care techniques. Nationally, 24% of physicians received some form of capitation payment for their patients. The two most widely used techniques were utilization review (UR), applied to an average of 59% of patients, and discounted fees, applied to an average of 38% of patients. Although UR was common, ultimate denial rates of coverage were very low: at most 3% for the types of care studied. Use of managed care techniques varied more within states than between states. Conventional measures of HMO market penetration revealed little about how managed care affects physicians.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0046-9580 1945-7243