Although the goals of managed careproviding quality care and preventive services at reasonable costsremain promising, the survey finds a high level of frustration among physicians in areas such as loss of autonomy in making medical decisions, decreased time spent with patients, increased administrative burdens in dealing with insurance plan practice guidelines and utilization rules, and loss of continuity of care when patients' insurance coverage changes.
Nearly 90 percent of all physicians surveyed participate in at least one managed care plan and care for at least some managed care patients. Half of physicians surveyed are members of five or more separate plans, the most usual arrangement being plans paying discounted fee-for-service. Plans which pay physicians a set monthly sum to care for each patient account for only a small share (4%) of all physicians' patients.
Clinical autonomy emerges as a concern for physicians trying to operate within managed care environments: 38 percent of physicians say they have less control in their ""ability to make decisions they think are right for their patients"" than they did three years ago.
Four in ten (41%) physicians also report they are spending less time with patients than three years ago.
Patient turnover due to changes in insurance coverage is also a problem. In markets with high managed care penetration, nearly half of all physicians report they have lost 10 percent of their patients when patients' insurance plans changed.
One in ten physicians report they have a financial incentive not to refer patients for specialty services; up to 31 percent report having been denied their referrals for mental health, substance abuse, or physical therapy.
Facts and Figures
- Seventy percent of physicians practicing primarily in discounted and capitated provider payment plans report ""very serious"" or ""somewhat serious"" problems with limits on hospital length of stay, and 57 percent report problems with limits on approval for hospital admissions.
- More than eight in ten physicians in managed care plans report ""somewhat or very serious"" problems with being able to refer patients to specialists of their choice.
- One in five physicians has left a managed care plan in the past three years.
- One in four physicians who tried to join an HMO in the past three years has been denied entry.