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Pressures on the Health Care Safety Net: Health Services Research |
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Ability to Obtain Medical Care for the Uninsured Journal of the American Medical Association |
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A Changing Picture of Uncompensated Care Health Affairs |
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| March 1999 Research Report No. 03 |
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Managed Care and Physicians' Provision of Charity Care
March 24-31, 1999
Journal of the American Medical Association, vol.281, no.12 (March 24-31, 1999): 1087-1092
Peter J. Cunningham, Joy M. Grossman, Robert F. St. Peter, Cara S. Lesser
ealth system changes may affect the ability of physicians to provide
uncompensated care and may therefore result in decreased access to health care for people
without health insurance. The authors looked at the Community Tracking Study’s survey data
from a national sample of almost 11,000 physicians from 60 communities and found that 77.3
percent of them provided an average of 10.3 hours of charity care per week. Physicians who
derive at least 85 percent of their practice revenue from managed care plans were
considerably less likely to provide charity care than physicians with little involvement
with managed care. In addition, physicians who practice in areas with high managed care
penetration provide fewer hours of charity care than physicians in other areas, regardless
of their own involvement in managed care. Differences in the provision of charity care
also were affected by ownership of the practice and practice arrangements. The authors
interpret the findings as indicating that financial pressures from managed care may be
limiting the amount of charity care provided by physicians. This may result in reduced
access to physicians among uninsured persons, and shift an even higher burden of
uncompensated care onto traditional safety net providers, such as public hospitals and
community health centers.
Free access to this article is available at the Journal of the American Medical Association Web site.
