Through the use of financial incentives, administrative rules and selection of physicians it is widely believed that managed care organizations (MCOs) are altering physician practice in order to ration use of expensive services and to increase reliance on primary care. We examine 4 questions: Q1: Are there differences in the scope of physician practice, referral patterns and complexity of case mix associated with physician involvement in managed care? Q2: Are differences due to: a) Changes in physician behavior or (b) Plans selecting physicians with conforming practice styles? Q3: Does the growth of managed care lead to community-wide changes in patterns of care through shifts in prices, resource availability, or norms? Q4: How are contracting patterns and specialty training related to physicians' perceptions of the appropriateness of care and case mix? We use the 1995 CSHSC Survey of Physicians, covering 2000 physicians in 60 PMSAs, and merge market level characteristics, data on managed care penetration measure competition and local sociodemographics. We employ multivariate regression analysis. The endogeneity of managed care penetration is addressed by two stage least squares. Findings document substantial differences between physicians with and without MCO contracts in their involvement in primary care services and scope of practice. MCO contract form matters. Practice patterns differ substantially between physicians with and without capitated contracts. Referral patterns and physicians' perceptions about the appropriateness of their case mix are affected by managed care contracting patterns.
Learning Objectives: Understand how manged care has changed physician scope of practice Identfy issues in linking specialty training to practice activities Understand implications of changing practice scope for workforce policy
Keywords: Managed Care, Workforce
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.