Physicians' Assessments of Their Ability to Provide High Quality Care in a Changing Health Care System

March 2001
Medical Care , Vol. 39, No. 3 (March 2001): 254-269
James D. Reschovsky, Marie C. Reed, David Blumenthal, Bruce Landon

he rapid spread of managed care in the U.S. over the past decade has had dramatic effects on the practice and organization of medical care. The growth of managed care and the associated market competition are widely credited for controlling rapid increases in health care costs. However, there is a growing chorus of concern that these changes may be compromising the quality of medical care. The study’s objective was to assess physicians’ perceptions of their ability to provide high quality care and explore what factors, including managed care, affect these perceptions.

The research design consisted on analyses of the Community Tracking Study Physician Survey, a cross-sectional, nationally representative telephone survey of 12,385 patient-care physicians providing direct patient care at least 20 hours per week, excluding federal employees and selected specialties, conducted in 1996-97 (the response rate was 65 percent).

The survey asked for a level of agreement with four statements, one regarding overall ability to provide high quality care, and three concerning aspects of care delivery associated with quality. Overall, large majorities of physicians reported that it is possible to provide high-quality care to all their patients. However, between a fifth and a third of physicians disagreed with each of the quality statements. Specialists were generally 50 percent more likely than patient-care physicians to express concerns about their ability to provide quality care.

The study found that managed care involvement is only modestly associated with reduced perceptions of quality among physicians, with some specific tools enhancing perceived quality. Physicians may be able to moderate some negative effects of managed care by altering their practice arrangements.

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