PRIMARY CARE: Study Finds HMO Practices Are Discriminatory
"[P]rimary care physicians who provide a disproportionate amount of care to the uninsured and to nonwhite patients are significantly less likely to have managed care" contracts, according to a study in today's issue of the Journal of the American Medical Association. The study, which surveyed 947 primary care physicians from the 13 largest urban counties in California, found that although physician exclusion from managed care contracts is "relatively common," it "does not appear to be systematically based on physician characteristics," such as race or age, "but it may be biased against physicians who provide greater amounts of care to the underserved." According to the study's authors, selective contracting by managed care plans threatens to have an enormous impact on physicians because "[a]s managed care comes to increasingly dominate the health insurance market, physicians excluded from managed care networks face the prospect of becoming physicians without patients" (Bindman, et al, 3/4 issue).
The study found that "doctors who treated the highest percentage of uninsured patients were 70% less likely to have an HMO contract than those who saw fewer charity care patients." The study also "found that doctors who spent the most time with the uninsured were 40% more likely to have been turned down or dumped from" the panel of an HMO, the San Francisco Chronicle reports. And, doctors did not have to see very many poor patients in order to be impacted. The study found that "low HMO participation rates were found among primary care physicians who reported that only 4% or more of their patients were uninsured" (Russell, 3/4). The study also found that doctors "who were practicing by themselves were most likely to have been left out by HMOs ... probably because they have less clout in negotiating with insurers."
Things To Come
UC-San Francisco associate professor of medicine Dr. Andrew Bindman, lead author of the study, said, "If there is a bias against those who treat minorities and the uninsured, that could encourage doctors to shy away from such patients in a bid to get contracts with managed care companies." The Boston Globe notes that while the study focuses on California, "that state is considered a harbinger of what could lie ahead for the rest of the country in managed care" (Tye, 3/4). Bindman said, "What we found is certainly worrisome ... [r]ather than rewarding these physicians for their social responsibility, the marketplace seems to be excluding them. If the penalty for caring [for] this population is exclusion, then more office-based physicians may decide they cannot afford to provide it" (UCSF release, 3/3).