Managed care, doctors, and patients: Focusing on relationships, not rights

Cambridge Quarterly of Healthcare Ethics

Volumn 12, Issue 3, 2003, Pages 300-307

  Shapiro, Robyn S ^a   Tym, Kristen A ^a   Eastwood, D A N ^a   Derse, Arthur R ^a   Klein, John P ^a  

^a MEDICAL COLLEGE OF WISCONSIN   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

DEMOGRAPHY; DOCTOR PATIENT RELATION; FIRST AID; HEALTH CARE; HEALTH CARE ACCESS; HEALTH CARE COST; HEALTH CARE DELIVERY; HEALTH INSURANCE; HEALTH MAINTENANCE ORGANIZATION; HEALTH SERVICE; HEALTH STATUS; HEALTH SURVEY; HUMAN; HUMAN RIGHTS; INTERVIEW; MANAGED CARE; MEDICAL FEE; MEDICAL SERVICE; PATIENT; PATIENT CARE; PHYSICIAN; REVIEW;

EMPIRICAL APPROACH; HEALTH CARE AND PUBLIC HEALTH; PROFESSIONAL PATIENT RELATIONSHIP;

ADOLESCENT; ADULT; AGED; AGED, 80 AND OVER; FEMALE; HEALTH SERVICES ACCESSIBILITY; HEALTH SERVICES RESEARCH; HUMANS; INSURANCE COVERAGE; MALE; MANAGED CARE PROGRAMS; MIDDLE AGED; PATIENT SATISFACTION; PHYSICIAN-PATIENT RELATIONS; SAMPLING STUDIES; TELEPHONE; WISCONSIN;

EID: 0038118104     PISSN: 09631801     EISSN: None     Source Type: Journal    
DOI: 10.1017/S0963180103123134     Document Type: Review

References (15)

1. Shapiro RS, Tym KA, Gudmundson JL, Derse AR, Klein JP. Managed care: effects on the physician-patient relationship. Cambridge Quarterly of Healthcare Ethics 2000;9(1):71-81.
2. See note 1, Shapiro, Tym, Gudmundson, Derse, Klein 2000.
3. Agresti A. Categorical Data Analysis. New York: Wiley; 1990.
4. Agresti A. Analysis of Ordinal Categorical Data. New York: Wiley; 1984.
5. See note 4, Agresti 1984.
6. See note 1, Shapiro, Tym, Gudmundson, Derse, Klein 2000.
7. Rodwin MA. Medicine, Money and Morals: Physicians' Conflicts of Interest. New York: Oxford University Press; 1993; Gold MR, Hurley R, Lake T, Ensor R, Berenson R. A national survey of the arrangements managed care plans make with physicians. New England Journal of Medicine 1995;333(25):1678-83; Hillman AL, Welch WP, Pauly MV. Contractual arrangements between HMOs and primary care physicians: three-tiered HMOs and risk pools. Medical Care 1992;30(2):136-48.
8. Rodwin MA. Medicine, Money and Morals: Physicians' Conflicts of Interest. New York: Oxford University Press; 1993; Gold MR, Hurley R, Lake T, Ensor R, Berenson R. A national survey of the arrangements managed care plans make with physicians. New England Journal of Medicine 1995;333(25):1678-83; Hillman AL, Welch WP, Pauly MV. Contractual arrangements between HMOs and primary care physicians: three-tiered HMOs and risk pools. Medical Care 1992;30(2):136-48.
9. Rodwin MA. Medicine, Money and Morals: Physicians' Conflicts of Interest. New York: Oxford University Press; 1993; Gold MR, Hurley R, Lake T, Ensor R, Berenson R. A national survey of the arrangements managed care plans make with physicians. New England Journal of Medicine 1995;333(25):1678-83; Hillman AL, Welch WP, Pauly MV. Contractual arrangements between HMOs and primary care physicians: three-tiered HMOs and risk pools. Medical Care 1992;30(2):136-48.
10. Blendon RJ, Knox RA, Brodie M, Benson JM, Chervinsky G. Americans compare managed care, Medicare, and fee-for-service. Journal of American Health Policy 1994;4(3):42-7.
11. Some have forcefully argued that managed care organizations, as well as physicians, should be regarded as fiduciaries of patients, with duties to promote patients' interests. See, for example: Morreim EH. To tell the truth: disclosing the incentives and limits of managed care. American Journal of Managed Care 1997;3(1):35-43.
12. Starfield B. Primary Care: Concept, Evaluation, and Policy. New York: Oxford University Press; 1992.
13. Kaplan SH, Greenfield S, Ware JE Jr. Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Medical Care 1989;27(3):S110-27.
14. See, for example: Beckman HB, Markakis KM, Suchman AL, Frankel RM. The doctor-patient relationship and malpractice: lessons from plaintiff depositions. Archives of Internal Medicine 1994;154(12):1365-70.
15. Factors associated with higher stress levels among physicians in our first survey were: (a) a larger prevalence of managed care in their practices; (b) greater restrictions on time the physicians could spend with their patients; and (c) less physician satisfaction with their patients' access to specialty care, emergency care, and diagnostic testing. See note 1, Shapiro, Tym, Gudmundson, Derse, Klein 2000.