Casalino Lawrence P, Devers Kelly J, Lake Timothy K, Reed Marie, Stoddard Jeffrey J
Department of Health Studies, University of Chicago, Chicago, IL 60637, USA.
Arch Intern Med. 2003 Sep 8;163(16):1958-64. doi: 10.1001/archinte.163.16.1958.
For decades, reformers argued that medical groups can efficiently provide high-quality care and a collegial professional environment. The growth of managed care and the movement to improve quality provide additional reasons for physicians to practice in groups, especially large groups. However, information is lacking on recent trends in group size and the benefits of and barriers to group practice.
To identify benefits of and barriers to large medical group practice, and to describe recent trends in group size.
DESIGN, SETTING, AND PARTICIPANTS: Information on benefits and barriers was obtained from 195 interviews conducted during round 3 (2000-2001) of the Community Tracking Study with leaders of the largest groups, hospitals, and health insurance plans in 12 randomly selected metropolitan areas. Information on recent trends in group size was obtained from more than 6000 physicians in private practice in 48 randomly selected metropolitan areas via Community Tracking Study telephone surveys in 1997-1998, 1998-1999, and 2000-2001.
Benefits of and barriers to large group practice, as perceived by interviewees, and changes in percentages of physicians in groups of varying sizes.
Gaining negotiating leverage with health insurance plans was the most frequently cited benefit; it was cited 8 times more often than improving quality. Lack of physician cooperation, investment, and leadership were the most frequently cited barriers. Survey data indicate that 47% of private physicians work in practices of 1 or 2 physicians and 82% in practices of 9 or fewer, and that the percentage of physicians in groups of 20 or more did not increase between 1996 and 2001.
Current payment methods reward gaining size to obtain negotiating leverage more than they reward quality. However, barriers to creating large medical groups are substantial, and most private physicians continue to practice in small groups, although the size of these groups is slowly increasing.
几十年来，改革者一直认为医疗集团能够高效地提供高质量医疗服务以及营造合作性的专业环境。管理式医疗的发展以及提高医疗质量的行动为医生加入集团行医，尤其是大型集团，提供了更多理由。然而，目前缺乏关于集团规模的近期趋势以及集团行医的益处和障碍的信息。
确定大型医疗集团行医的益处和障碍，并描述集团规模的近期趋势。
设计、地点和参与者：关于益处和障碍的信息来自于在社区追踪研究的第三轮（2000 - 2001年）期间对12个随机选取的大都市地区最大的医疗集团、医院及健康保险计划的领导者进行的195次访谈。关于集团规模近期趋势的信息来自于1997 - 1998年、1998 - 1999年以及2000 - 2001年通过社区追踪研究电话调查对48个随机选取的大都市地区6000多名私人执业医生的调查。
受访者所感知的大型集团行医的益处和障碍，以及不同规模集团中医生比例的变化。
与健康保险计划获得谈判优势是最常被提及的益处，其被提及的频率比提高医疗质量高出8倍。医生缺乏合作、投资和领导力是最常被提及的障碍。调查数据表明，47%的私人医生在由1名或2名医生组成的诊所工作，82%的医生在9名或更少医生组成的诊所工作，并且在1996年至2001年期间，20名或更多医生组成的集团中医生的比例没有增加。
当前的支付方式奖励扩大规模以获得谈判优势，而不是奖励医疗质量。然而，组建大型医疗集团存在重大障碍，尽管这些集团的规模在缓慢增长，但大多数私人医生仍继续在小型集团中行医。
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