Effects of Managed Care on the Length of Time That Elderly Patients Spend With Physicians During Ambulatory Visits

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Abstract
To examine the factors related to the length of time that elderly patients spend with physicians during ambulatory visits and explore specifically the association between managed care and visit duration. Cross-sectional analysis of the 1998 National Ambulatory Medical Care Survey. Four thousand nine hundred sixty-four office visits to nonfederally employed physicians by elderly patients who had face-to-face contact with physicians and had complete information on variables related to managed care. Information was collected on the characteristics of patient, physician and clinic, visit duration, reasons for visit, diagnoses, clinical services performed, and medications ordered. Measures of managed care included patient's health maintenance organization (HMO) status, requirement of authorization, capitation, and HMO ownership of the clinic. The mean visit duration was 19.2 minutes for elderly patients (27.0 minutes for new patients and 18.3 minutes for established patients; P <0.001). In bivariate analyses, the patient's HMO status was not associated with visit duration, but office visits for patients seen at clinics owned by HMOs were 4.2 minutes shorter than those seen in other settings (P <0.001). In multivariate analyses with mixed-effect models, HMO-owned clinic was an independent predictor for shorter visit duration, after adjusting for other patient, physician, and clinic characteristics and type of service provided. The effects of managed care on the duration of ambulatory visits by elderly patients appear to be related to the structure of the managed care plan rather than managed care reimbursement per se.