PHYSICIANS: SATISFACTION LOWER IN HIGH MANAGED CARE AREAS
Physicians practicing in states with high managed careThis is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.
penetration are more likely to report "serious problems" in
several aspects of caring for patients, according to a new Harris
poll. The poll was conducted by Harvard University researchers
and Louis Harris and Associates, Inc. It surveyed 2,003
practicing physicians in 1995, with a special emphasis on those
in states with the highest HMO enrollment -- Massachusetts,
California, Minnesota and Oregon. Researchers found that 55% of
all physicians surveyed reported that the U.S. health care system
had gotten worse within the year before the survey. Sixty-seven
percent of doctors in high HMO enrollment states said that
"movement of patients in and out of their practice because of
insurance changes" is a serious problem, versus 48% of those in
low HMO-enrollment states who said they had the same problem.
Researchers also found that physicians in states with high
HMO enrollment were more likely to report the following items as
serious problems in their practices: limits on referring
patients to specialists (42% in high states, 25% in low states);
limits on ordering necessary tests and procedures (41% in high
states, 27% in low states); patients who should have been
referred for medical attention sooner (44% in high states, 37% in
low states) and pressure to see more patients than the doctor
thinks appropriate (37% in high states, 28% in low states).
However, doctors in high HMO-enrollment states reported slightly
lower rates of limitations on hospital stays. Forty-four percent
of doctors in high HMO enrollment areas reported limitations on
lengths of hospital stays, compared with 49% of doctors in low
The authors note that the data were collected in a rapidly
changing environment. Nonetheless, they note that the managed
care markets were relatively mature in the high HMO-enrollment
states versus the other states at the time the data were
collected and may provide a glimpse of problem areas to come.
Dr. Karen Donelan, the study's lead author, noted that "the areas
highlighted as problems by doctors in heavy managed care markets
have also been noted by patients and consumers assessing managed
care plans" (Harris Poll release, 11/24).