Managed care and physicians' provision of charity care.

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Abstract
Physicians are an important source of health care for many uninsured and underinsured persons, as evidenced by the fact that a physician's office is the usual source of care for about one third of uninsured persons,1 and physician uncompensated care costs were estimated as high as $11 billion in 1994.2 Yet, there is much concern about how changes in the health care system—especially the role of managed care—may affect physicians' willingness to provide care to the medically indigent (ie, patients who are unable to pay because they are uninsured or underinsured). Because managed care attempts to impose greater price discipline on health care practitioners through discounted fees, capitated payments, selective contracting, and other methods, the result is that many physicians are experiencing increased financial pressures, greater competition for paying patients, and less ability to shift the costs of uncompensated care onto other payers.3 As a result, many physicians may reduce or altogether eliminate charity care to the medically indigent.