The Provision of Primary Care: Does Managed Care Make a Difference?

Health Affairs

Volumn 16, Issue 6, 1997, Pages 89-98

  Simon, Carol J ^a   White, William D ^a   Gamliel, Sandy ^a   Kletke, Phillip R ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; HEALTH CARE QUALITY; HEALTH INSURANCE; HUMAN; MANAGEMENT; MEDICINE; PRIMARY HEALTH CARE; STATISTICS; TASK PERFORMANCE; UNITED STATES;

HUMANS; MANAGED CARE PROGRAMS; PRACTICE MANAGEMENT, MEDICAL; PRIMARY HEALTH CARE; QUALITY OF HEALTH CARE; SPECIALTIES, MEDICAL; TIME AND MOTION STUDIES; UNITED STATES;

EID: 0347303598     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.16.6.89     Document Type: Article

References (15)

1. J.P. Weiner, "Forecasting the Effects of Health Reform on U.S. Physician Workforce Requirement," Journal of the American Medical Association 272, no. 3 (1994): 222-230.
2. Ibid.; Council on Graduate Medical Education, Patient Care, Physician Supply, and Workforce Requirements, Eighth Report (Rockville, Md.: U.S. Department of Health and Human Services, November 1996); and J. Wennberg et al., "Finding Equilibrium in U.S. Physician Supply," Health Affairs (Spring 1993): 89-103.
3. Ibid.; Council on Graduate Medical Education, Patient Care, Physician Supply, and Workforce Requirements, Eighth Report (Rockville, Md.: U.S. Department of Health and Human Services, November 1996); and J. Wennberg et al., "Finding Equilibrium in U.S. Physician Supply," Health Affairs (Spring 1993): 89-103.
4. Ibid.; Council on Graduate Medical Education, Patient Care, Physician Supply, and Workforce Requirements, Eighth Report (Rockville, Md.: U.S. Department of Health and Human Services, November 1996); and J. Wennberg et al., "Finding Equilibrium in U.S. Physician Supply," Health Affairs (Spring 1993): 89-103.
5. L.G. Hart et al., "Physician Staffing Ratios in Staff-Model HMOs: A Cautionary Tale," Health Affairs (January/February 1997): 55-70.
6. C.J. Simon and P.H. Born, "Physician Earnings in a Changing Managed Care Environment," Health Affairs (Fall 1996): 124-133; and C.J. Simon, W.D. White, and D. Dranove, "The Impact of Managed Care on the Physician Marketplace," Public Health Reports (May/June 1997): 222-230.
7. C.J. Simon and P.H. Born, "Physician Earnings in a Changing Managed Care Environment," Health Affairs (Fall 1996): 124-133; and C.J. Simon, W.D. White, and D. Dranove, "The Impact of Managed Care on the Physician Marketplace," Public Health Reports (May/June 1997): 222-230.
8. P. Franks, C. Clancy, and P. Nutting, "Gatekeeping Revisited - Protecting Patients from Overtreatment," The New England Journal of Medicine 327, no. 6 (1992): 424-429.
9. A practice's managed care revenues may differ from those of a physician. The SMS, however, only collects data on revenues at the practice level.
10. OB/GYNs are included here as specialists for purely empirical reasons. We acknowledge that the AMA recognizes OB/GYNs as PCPs.
11. Regression analysis is used to predict the proportion of time individual physicians spent in primary care, using weighted least squares regression for primary care physicians and tobit analysis for specialists. Weights adjust for known sources of survey nonresponse bias. Gender, board certification, multispecialty group structure, practice size, and specialty were significant for both PCPs and specialists. Employee status was significant for specialists only. Full results are available from the authors. Write to Carol J. Simon, Institute of Government and Public Affairs, University of Illinois, Suite 525, 815 West Van Buren Street, Chicago, Illinois 60607.
12. The organization of physician practices and managed care contracting are different in rural areas. Our sample of nonurban physicians is too small to explain these differences.
13. Managed care penetration rates in our sample range from less than 20 percent to more than 50 percent, which allowed us to compare patterns of physician activities across markets. Our final sample contains 719 PCPs and 1,281 specialist physicians.
14. C.J. Simon and D.W. Emmons, "Physician Earnings at Risk: An Analysis of the Extent of Capitated Payments to Physicians," Health Affairs (May/June 1997): 120-126.
15. Simon et al., "The Impact of Managed Care on the Physician Marketplace."