Simon S R, Pan R J, Sullivan A M, Clark-Chiarelli N, Connelly M T, Peters A S, Singer J D, Inui T S, Block S D
Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass 02215, USA.
N Engl J Med. 1999 Mar 25;340(12):928-36. doi: 10.1056/NEJM199903253401206.
Views of managed care among academic physicians and medical students in the United States are not well known. In 1997, we conducted a telephone survey of a national sample of medical students (506 respondents), residents (494), faculty members (728), department chairs (186), directors of residency training in internal medicine and pediatrics (143), and deans (105) at U.S. medical schools to determine their experiences in and perspectives on managed care. The overall rate of response was 80.1 percent.
Respondents rated their attitudes toward managed care on a 0-to-10 scale, with 0 defined as "as negative as possible" and 10 as "as positive as possible." The expressed attitudes toward managed care were negative, ranging from a low mean (+/-SD) score of 3.9+/-1.7 for residents to a high of 5.0+/-1.3 for deans. When asked about specific aspects of care, fee-for-service medicine was rated better than managed care in terms of access (by 80.2 percent of respondents), minimizing ethical conflicts (74.8 percent), and the quality of the doctor-patient relationship (70.6 percent). With respect to the continuity of care, 52.0 percent of respondents preferred fee-for-service medicine, and 29.3 percent preferred managed care. For care at the end of life, 49.1 percent preferred fee-for-service medicine, and 20.5 percent preferred managed care. With respect to care for patients with chronic illness, 41.8 percent preferred fee-for-service care, and 30.8 percent preferred managed care. Faculty members, residency-training directors, and department chairs responded that managed care had reduced the time they had available for research (63.1 percent agreed) and teaching (58.9 percent) and had reduced their income (55.8 percent). Overall, 46.6 percent of faculty members, 26.7 percent of residency-training directors, and 42.7 percent of department chairs reported that the message they delivered to students about managed care was negative.
Negative views of managed care are widespread among medical students, residents, faculty members, and medical school deans.
美国学术型医生和医学生对管理式医疗的看法尚不清楚。1997年，我们对美国医学院校的医学生（506名受访者）、住院医师（494名）、教员（728名）、系主任（186名）、内科和儿科住院医师培训项目主任（143名）以及院长（105名）进行了全国性电话调查，以了解他们在管理式医疗方面的经历和看法。总体回复率为80.1%。
受访者对管理式医疗的态度按0至10分进行评分，0分定义为“尽可能负面”，10分定义为“尽可能正面”。对管理式医疗表达的态度较为负面，住院医师的平均（±标准差）得分较低，为3.9±1.7分，院长的得分最高，为5.0±1.3分。当被问及医疗的具体方面时，在获得医疗服务（80.2%的受访者认为）方面，按服务收费的医疗模式比管理式医疗得到的评价更高，在尽量减少伦理冲突（74.8%）和医患关系质量（70.6%）方面也是如此。在医疗连续性方面，52.0%的受访者更喜欢按服务收费的医疗模式，29.3%的受访者更喜欢管理式医疗。在临终关怀方面，49.1%的受访者更喜欢按服务收费的医疗模式，20.5%的受访者更喜欢管理式医疗。在慢性病患者护理方面，41.8%的受访者更喜欢按服务收费的医疗，30.8%的受访者更喜欢管理式医疗。教员、住院医师培训项目主任和系主任表示，管理式医疗减少了他们可用于研究的时间（63.1%的人表示同意）和教学时间（58.9%），并减少了他们的收入（55.8%）。总体而言，46.6%的教员、26.7%的住院医师培训项目主任和42.7%的系主任报告称，他们向学生传达的关于管理式医疗的信息是负面的。
医学生、住院医师、教员和医学院院长对管理式医疗普遍持负面看法。
