Does Managed Care Restrictiveness Affect the Perceived Quality of Primary Care? A Report from ASPN

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Original Research

Does Managed Care Restrictiveness Affect the Perceived Quality of Primary Care? A Report from ASPN

J Fam Pract. 1999 October;48(10):762-768

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Replication of this study in a larger number of community-based practice sites and in a general community sample would add to the generalizability of the findings. In these times of increased business interest in medicine,³⁷ it is important to continue to monitor and evaluate the immediate, long-term, intended, and unintended outcomes of specific features of managed care.

Conclusions

Managed care plan restrictiveness does not appear to be affecting the delivery of primary care as measured from the perspective of the patient. However, the financial and organizational restrictiveness of managed care plans does lead to greater clinician hassle. We interpret these results to suggest that primary care clinicians are able to effectively buffer the effects of health plan structure on their patients. These findings raise questions about the effect of plan restrictiveness on efficient use of clinician time and the clinician’s ability to continue to deliver quality primary care amidst competing administrative demands.

Acknowledgments

We would like to thank each of the participating ASPN practices, their staffs, and patients, without whom the study would not have been possible. The practices participating in this study included the following: Batesville Family Practice Clinic, Batesville, Arkansas; Loma Linda University, Department of Family Medicine, Loma Linda, California; C. Frazer Shipman, Wheatridge, Colorado; The Family Medical Group, Bristol, Connecticut; St. John’s Mercy Family Medicine, St. Louis, Missouri; Manchester Family Health Center, Manchester, New Hampshire; Primary Care Center at Hillsborough, Belle Mead, New Jersey, and Family Medicine at Monument Square, New Brunswick, New Jersey; Central Square Health Services Center, Central Square, New York; Enid Family Medicine Clinic, Enid, Oklahoma; Good Samaritan Family Practice, ELCO, Lebanon, Pennsylvania; Michael Hartsell, MD, Greeneville, Tennessee; Annadale Family Medicine, PC, Annadale, Virginia, and Tappahannack Family Practice, Tappahannack, Virginia; and Cle Elum Family Medicine Center, Cle Elum, Washington.

Thanks to each of the ASPN Managed Care Task Force members who developed the Managed Care Survey and pilot tested the project instruments and protocol: A. John Orzano, MD; H. Andrew Selinger, MD; Robert James, MD; William Fosmire, MD; Linda French, MD; Frank Reed, MD; John Scott, MD; and Dennis de Leon, MD.