Flocke S A, Orzano A J, Selinger H A, Werner J J, Vorel L, Nutting P A, Stange K C
Department of Family Medicine at Case Western Reserve University, Cleveland, OH 44106-7136, USA.
J Fam Pract. 1999 Oct;48(10):762-8.
The competitive managed care marketplace is causing increased restrictiveness in the structure of health plans. The effect of plan restrictiveness on the delivery of primary care is unknown. Our purpose was to examine the association of the organizational and financial restrictiveness of managed care plans with important elements of primary care, the patient-clinician relationship, and patient satisfaction.
We conducted a cross-sectional study of 15 member practices of the Ambulatory Sentinel Practice Network selected to represent diverse health care markets. Each practice completed a Managed Care Survey to characterize the degree of organizational and financial restrictiveness for each individual health care plan. A total of 199 managed care plans were characterized. Then, 1475 consecutive outpatients completed a patient survey that included: the Components of Primary Care Instrument as a measure of attributes of primary care; a measure of the amount of inconvenience involved with using the health care plan; and the Medical Outcomes Study Visit Rating Form for assessing patient satisfaction.
Clinicians' reports of inconvenience were significantly associated (P < .001) with the financial and organizational restrictiveness scores of the plan. There was no association between plan restrictiveness and patient report of multiple aspects of the delivery of primary care or patient satisfaction with the visit.
Plan restrictiveness is associated with greater perceived hassle for clinicians but not for patients. Plan restrictiveness seems to be creating great pressures for clinicians, but is not affecting patients' reports of the quality of important attributes of primary care or satisfaction with the visit. Physicians and their staffs appear to be buffering patients from the potentially negative effects of plan restrictiveness.
竞争激烈的管理式医疗市场导致健康计划结构的限制日益增加。计划限制对初级保健服务提供的影响尚不清楚。我们的目的是研究管理式医疗计划的组织和财务限制与初级保健的重要要素、患者-临床医生关系及患者满意度之间的关联。
我们对门诊哨兵实践网络的15个成员机构进行了横断面研究，这些机构被选为代表不同的医疗保健市场。每个机构完成了一份管理式医疗调查问卷，以描述每个个体医疗保健计划的组织和财务限制程度。共对199个管理式医疗计划进行了特征描述。然后，1475名连续门诊患者完成了一份患者调查问卷，其中包括：作为初级保健属性衡量指标的初级保健要素量表；衡量使用医疗保健计划所带来不便程度的指标；以及用于评估患者满意度的医疗结果研究就诊评分表。
临床医生报告的不便程度与计划的财务和组织限制得分显著相关（P <.001）。计划限制与患者对初级保健服务提供多个方面的报告或患者对就诊的满意度之间没有关联。
计划限制与临床医生感受到的更大麻烦相关，但与患者无关。计划限制似乎给临床医生带来了巨大压力，但并未影响患者对初级保健重要属性质量的报告或对就诊的满意度。医生及其工作人员似乎在保护患者免受计划限制可能带来的负面影响。
