Despite the growth of managed care in the United States, there is little information about the arrangements managed-care plans make with physicians.
In 1994 we surveyed by telephone 138 managed-care plans that were selected from 20 metropolitan areas nationwide.
Of the 108 plans that responded, 29 were group-model or staff-model health maintenance organizations (HMOs), 50 were network or independent-practice-association (IPA) HMOs, and 29 were preferred-provider organizations (PPOs).
Respondents from all three types of plan said they emphasized careful selection of physicians, although the group or staff HMOs tended to have more demanding requirements, such as board certification or eligibility.
Sixty-one percent of the plans responded that physicians'previous patterns of costs or utilization of resources had little influence on their selection ; 26 percent said these factors had a moderate influence ; and 13 percent said they had a large influence.
Some risk sharing with physicians was typical in the HMOs but rare in the PPOs.
Fifty-six percent of the network or IPA HMOs used capitation as the predominant method of paying primary care physicians, as compared with 34 percent of the group or staff HMOs and 7 percent of the PPOs.
More than half the HMOs reported adjusting payments according to utilization or cost patterns, patient complaints, and measures of the quality of care.
Ninety-two percent of the network or IPA HMOs and ...
Mots-clés Pascal : Organisation santé, Soin santé primaire, Arrangement, Paiement, Médecin, Centre santé, Etude comparative, Homme, Etats Unis, Amérique du Nord, Amérique
Mots-clés Pascal anglais : Public health organization, Primary health care, Arrangement, Payment, Physician, Health center, Comparative study, Human, United States, North America, America
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 96-0076683
Code Inist : 002B30A06B. Création : 199608.