Minority physicians and selective contracting in competitive market environments.

This study used a framework of strategic behavior to further explore MCOs' physician contractual decision making. Using data from a cross-sectional mail survey of 1,215 physicians, we tested the assumption that a physician's patient profile is related to higher rates of contract denial or termination when adjusted and unadjusted for the level of managed care market competition. As minority physicians serve more minority patients who tend to have a poorer health status than white patients, we expected greater rates of contract denials and terminations for minority physicians when models are unadjusted for the level of market competition. In models adjusted for competition, we expected physician and patient race to be unrelated to MCO contractual decisions. We found physician ethnicity was not a predictor for contract denials or terminations, but patient ethnicity was a predictor for contract denials and terminations. When market competition is accounted for, the differences were almost unchanged.