Measuring the Physician Perspective on Quality of Care in Health Plans

Smith, Maureen A.; Brown, Michael; Borowsky, Steven J.; Davis, Margaret K.; Center, Bruce; Lurie, Nicole

doi:10.1177/01632780122034759

Cited by 5 publications

(6 citation statements)

References 16 publications

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“…They merit this involvement because their cooperation and participation are crucial to program success and because their perspectives can be an important source of information on health care quality and managed care plan performance (Borowsky, Davis, Goertz, & Lurie, 1997;Williams et al, 1999). In fact, recent research suggests that physicians' perceptions of health plan quality are distinguishable (even though highly correlated) from their underlying attitudes (including financial attitudes) toward the plan (Smith et al, 2001).…”

Section: Discussionmentioning

confidence: 99%

Caring for Patients Under Medicaid Mandatory Managed Care: Perspectives of Primary Care Physicians

Chaudry

Brandon²,

Thompson³

et al. 2003

Qual Health Res

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The purpose of the study was to describe the experiences of primary care physicians caring for Medicaid recipients in a demonstration mandatory health maintenance organization (HMO) managed care program. The authors collected data through semistructured individual or focus group interviews with 14 physicians and through interviews with the chief executive officers of the three HMOs participating in the demonstration program. Interview questions, developed initially from a review of the literature, addressed physicians' experiences as primary care providers for Medicaid recipients under traditional fee-for-service and under managed care arrangements through the demonstration program. Four themes emerged: providers' hassles and burdens, the complex needs of Medicaid patients, improved access to care under managed care, and individual providers' disconnect from the processes of health policy implementation and program evaluation.

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Section: Discussionmentioning

confidence: 99%

Caring for Patients Under Medicaid Mandatory Managed Care: Perspectives of Primary Care Physicians

Chaudry

Brandon²,

Thompson³

et al. 2003

Qual Health Res

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“…We found only two studies that addressed technical aspects of instrument development. Smith, Brown, et al (2001) used a theoretical framework that examined health plan practices that were hypothesized to create barriers to high-quality care and those believed to facilitate delivery of high-quality care. The third dimension of the framework was physician clinical capabilities.…”

Section: Instrument Developmentmentioning

confidence: 99%

“…The remaining surveys compared respondents to nonrespondents on variables such as age, gender, and medical specialty, and few differences were found. Fewer studies analyzed item nonresponse (Reschovsky et al 2001;Smith, Bindman, et al 2001;Smith, Brown, et al 2001). Smith, Bindman et al (2001) and Smith, Brown, et al (2001) restricted study analysis to PCPs because of the large item nonresponse among specialists.…”

Section: Samplingmentioning

confidence: 99%

“…Fewer studies analyzed item nonresponse (Reschovsky et al 2001;Smith, Bindman, et al 2001;Smith, Brown, et al 2001). Smith, Bindman et al (2001) and Smith, Brown, et al (2001) restricted study analysis to PCPs because of the large item nonresponse among specialists. For subsequent analyses, items with a less than 80 percent response rate were discarded, and after confirming that data were not missing completely at random, data imputation was carried out.…”

Section: Samplingmentioning

confidence: 99%

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Physicians’ Perceptions of Managed Care: A Review of the Literature

Christianson

Warrick²,

Wholey

2005

Med Care Res Rev

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In this article, the authors review the health services research literature regarding physician attitudes and opinions relating to managed care and how managed care has affected their clinical practice. This literature suggests that physician perceptions of managed care are largely related to the nature of their ties to managed care plans and to their selection of practice setting. There are substantial limitations in study designs and execution, suggesting that many of the published findings should be viewed with caution; the research basis regarding physicians’ perceptions of managed care is not as strong as the number of articles published on this subject would suggest. The review concludes with suggestions for the conduct of future research on this topic.

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“…It is not clear how these potentially conflicting biases weighed in our observed results. An apparently related limitation is that we did not directly measure quality of care in the health plans at issue, so we cannot know whether physicians' reports of plan quality are accurate 54 . But for this study we were interested in physician behaviors given their perceptions of health plan quality (whether accurate or not), since even inaccurate perceptions drive behavior.…”

Section: Discussionmentioning

confidence: 99%

Patient protection and risk selection

et al. 2002

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BACKGROUND: Individual physicians who are paid prospectively, as in capitated health plans, might tend to encourage patients to avoid or to join these plans according to the patient's health status. Though insurance risk selection has been well documented among organizations paid on a prospective basis, such physician‐level risk selection has not been studied. OBJECTIVE: To assess physician reports of risk selection in capitated health plans and explore potentially related factors. DESIGN AND PARTICIPANTS: National mailed survey of primary care physicians in 1997–1998, oversampling physicians in areas with more capitated health plans. RESULTS: The response rate was 63% (787 of 1,252 eligible recipients). Overall, 44% of physicians reported encouraging patients either to join or to avoid capitated health plans according to the patients' health status: 40% encouraged more complex and ill patients to avoid capitated plans and 23% encouraged healthier patients to join capitated plans. In multivariable models, physicians with negative perceptions of capitated plan quality, with more negative experiences in capitated plans, and those who knew at each patient encounter how they were being compensated had higher odds of encouraging sicker patients to avoid capitated plans (odds ratios, 2.0, 2.2, and 2.0; all confidence intervals >1). CONCLUSIONS: Many primary care physicians report encouraging patients to join or avoid capitated plans according to the patient's health status. Although these physicians' recommendations might be associated primarily with concerns about quality, they can have the effect of insulating certain health plans from covering sicker and more expensive patients.

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Measuring the Physician Perspective on Quality of Care in Health Plans

Cited by 5 publications

References 16 publications

Caring for Patients Under Medicaid Mandatory Managed Care: Perspectives of Primary Care Physicians

Caring for Patients Under Medicaid Mandatory Managed Care: Perspectives of Primary Care Physicians

Physicians’ Perceptions of Managed Care: A Review of the Literature

Patient protection and risk selection

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