Sloan Frank A, Rattliff John R, Hall Mark A
Center for Health Policy Duke University, Durham, North Carolina 27708, USA.
Med Care Res Rev. 2007 Oct;64(5):585-99. doi: 10.1177/1077558707300715.
Physician dissatisfaction often drives public policy, and is associated with lower quality of care and disruption of treatment relationships. Physicians expressed strong dissatisfaction with managed care, leading to enactment of patient protection laws. By 2001, almost all states enacted laws to curb alleged abuses of managed care organizations. To date, no studies have examined whether such laws improved physician satisfaction. This article examines whether enactment of these laws improved physician satisfaction, using responses to the Physician Survey component of the Community Tracking Study (CTS), supplemented with data on state statutes/regulations. Career satisfaction increased for both primary care physicians (PCPs) and specialists following enactment of such laws; improvements were limited to early-adopting states. Enactment was associated with improvements in early-adopting states for specialists but not for PCPs on: ability to provide high quality care, clinical freedom, and ability to make clinical decisions in patients' interests without sacrificing physician income.
医生的不满情绪常常推动公共政策的制定,并且与医疗质量下降和治疗关系的破裂有关。医生对管理式医疗表达了强烈不满,这导致了患者保护法的颁布。到2001年,几乎所有州都颁布了法律以遏制所谓的管理式医疗组织的滥用行为。迄今为止,尚无研究考察这些法律是否提高了医生的满意度。本文利用社区追踪研究(CTS)中医生调查部分的回复,并辅以州法规/条例数据,来考察这些法律的颁布是否提高了医生的满意度。在这类法律颁布后,初级保健医生(PCP)和专科医生的职业满意度都有所提高;改善仅限于早期采用这些法律的州。在早期采用这些法律的州,法律的颁布与专科医生在以下方面的改善有关,但与初级保健医生无关:提供高质量医疗服务的能力、临床自主权以及在不牺牲医生收入的情况下为患者利益做出临床决策的能力。