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What doctors think about the impact of managed care tools on quality of care, costs, autonomy, and relations with patients

DOI: 10.1186/1472-6963-10-331

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Mail survey of doctors (N = 1546) in Geneva, Switzerland. Respondents were asked to rate the impact of 8 managed care tools on 4 aspects of care on a 5-level scale (1 very negative, 2 rather negative, 3 neutral, 4 rather positive, 5 very positive). For each tool, we obtained a mean score from the 4 separate impacts.Doctors had predominantly negative opinions of the impact of managed care tools: use of guidelines (mean score 3.18), gate-keeping (2.76), managed care networks (2.77), second opinion requirement (2.65), pay for performance (1.90), pay by salary (2.24), selective contracting (1.56), and pre-approval of expensive treatments (1.77). Estimated impacts on cost control were positive or neutral for most tools, but impacts on professional autonomy were predominantly negative. Primary care doctors held more positive opinions than doctors in other specialties, and psychiatrists were in general the most critical. Older doctors had more negative opinions, as well as those in private practice.Doctors perceived most managed care tools to have a positive impact on the control of health care costs but a negative impact on medical practice. Tools that are controlled by the profession were better accepted than those that are imposed by payers."Managed care" is a global term for health care systems that integrate the delivery and financing of health care. Managed care contrasts with liberal medical practice, which allows doctors to make clinical decisions and bill for their services without interference from managers or payers. Traditional forms of managed care include the staff-model health maintenance organization (HMO) and the office-based independent provider association [1,2]. However, many variants exist. Luft notes that "in reality, each HMO is a highly complex combination of economic incentives, bureaucratic structures, and personalities" [3]. Another definition characterizes managed care programs by their use of a variety of interventions, including economic incen


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