Selection and exclusion of primary care physicians by managed care organizations.

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Abstract
MANAGED care has fundamentally altered the balance of power between physicians and third-party payers. One of the elements of managed care most responsible for this transformation is selective contracting.1 Patients enrolled in managed care plans must choose from a limited panel of physicians offered by the plan. Selective contracting, thus, places in the hands of managed care plans considerable power over the economic survival of practicing physicians, since contracts are a necessary condition for access to patients in these plans. As managed care comes to increasingly dominate the health insurance market, physicians excluded from managed care networks face the prospect of becoming physicians without patients.

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