The Provision Of Primary Care: Does Managed Care Make A Difference?

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Abstract
PROLOGUE: The policy world has been watching with interest the evolving relationships between physicians and managed care organizations. In the Summer 1996 issue of Health Affairs, David Blumenthal questioned the implications of competition for physicians and patient care. He argued that the administrative techniques that managed care organizations use to supervise physicians are a powerful force for change. He noted, however, that “evidence of the effectiveness of these techniques in reducing costs or improving quality is scant.” Indeed, little is known about the direct implications for practice styles. This paper by Carol Simon and colleagues provides some initial indications of how, specifically, the partnering of physicians and managed care organizations is linked with differences in practice patterns. With increasing demand for primary care services, they ask, are there discernible differences in the scope of practice of primary care and specialist physicians? Simon and colleagues are well qualified to take on this question. Simon is an associate professor at the School of Public Health and William White is a professor of economics at the University of Illinois at Chicago. Both hold appointments in the University of Illinois Institute of Government and Public Affairs. Sandy Gamliel is an economist and project officer in the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) bureau at the Health Resources and Services Administration at the U.S. Department of Health and Human Services. Phillip Kletke is senior social researcher at the American Medical Association's Center for Health Policy Research. Drawing on a nationally representative survey of physicians, this paper examines the extent to which physicians split their time between primary care and non-primary care activities and whether managed care makes a difference. We find that managed care does matter: Physicians have been narrowing their scope of practice, and the trend is linked to their involvement with managed care plans. These findings have implications for workforce policy and training, regulation of managed care contracting, and the quality of care.