医生对健康维护组织及按服务收费模式满意度的变化性质。

Changing nature of physician satisfaction with health maintenance organization and fee-for-service practices.

作者信息

Schulz R, Scheckler W E, Moberg D P, Johnson P R

机构信息

University of Wisconsin-Madison Medical School, USA.

出版信息

J Fam Pract. 1997 Oct;45(4):321-30.

PMID:9343053

Abstract

BACKGROUND

Managed care practice arrangements, or health maintenance organizations (HMOs), are sufficiently mature to examine whether physicians' level of satisfaction has changed as managed care has developed. This study compares Dane County, Wisconsin, physicians' satisfaction with HMO and fee-for-service (FFS) practices in 1986 with that of 1993 and examines factors that contribute to satisfaction in an HMO-dominated environment.

METHODS

Cross-sectional surveys were mailed to all Dane County physicians in active practice in 1986 and 1993. Physician overall support for HMO development and satisfaction with work situation was measured with single items. Overall satisfaction and clinical freedom within HMO and FFS practices were measured using statistically reliable scales.

RESULTS

Significantly more physicians were supportive of the development of HMOs in 1993 than in 1986, and more than two thirds of physicians in 1993 were satisfied in their current work situation. Primary care physicians were significantly more satisfied than subspecialists across most dimensions of satisfaction. Perceived clinical freedom and satisfaction with income continued to be major predictors of satisfaction in 1993 as in 1986. While physicians' satisfaction with HMO practice remained stable, their satisfaction with FFS practice was significantly lower in 1993 than in 1986. Satisfaction with Medicare practice, which was not measured in 1986, was significantly less than with HMO or FFS practice in 1993.

CONCLUSIONS

Analyses suggest that primary care physicians are more satisfied than subspecialists with their HMO practice because of their greater satisfaction with HMO-generated income and the expanded clinical freedom they have in HMO practice. An across-the-board decline in satisfaction with FFS practice may be attributable to diminishing clinical freedom resulting from indemnity carriers' increasing micromanagement of patient care.

摘要

背景

管理式医疗实践安排，即健康维护组织（HMOs），已足够成熟，可用于研究随着管理式医疗的发展，医生的满意度水平是否发生了变化。本研究比较了威斯康星州戴恩县1986年和1993年医生对HMO和按服务收费（FFS）模式的满意度，并探讨了在以HMO为主导的环境中影响满意度的因素。

方法

分别于1986年和1993年向戴恩县所有在职医生邮寄横断面调查问卷。用单项指标衡量医生对HMO发展的总体支持度以及对工作状况的满意度。使用具有统计学可靠性的量表来衡量医生对HMO和FFS模式的总体满意度及临床自主性。

结果

与1986年相比，1993年明显有更多医生支持HMO的发展，并且1993年超过三分之二的医生对当前工作状况感到满意。在大多数满意度维度上，初级保健医生的满意度明显高于专科医生。与1986年一样，1993年感知到的临床自主性和对收入的满意度仍然是满意度的主要预测因素。虽然医生对HMO模式的满意度保持稳定，但他们对FFS模式的满意度在1993年明显低于1986年。1986年未进行测量的对医疗保险模式的满意度，在1993年明显低于对HMO或FFS模式的满意度。