Abstract
BackgroundManaged care efforts to regulate access to specialists and reduce costs may lower quality of care. Few studies have examined whether managed care is associated with patient perceptions of the quality of care provided by physician and non-physician specialists. Aim is to determine whether associations exist between managed care controls and patient ratings of the quality of specialty care among primary care patients with pain and depressive symptoms who received specialty care for those conditions.MethodsA prospective cohort study design was conducted in the offices of 261 primary physicians in private practice in Seattle in 1997. Patients (N = 17,187) were screened in waiting rooms, yielding a sample of 1,514 patients with pain only, 575 patients with depressive symptoms only, and 761 patients with pain and depressive symptoms. Patients (n = 1,995) completed a 6-month follow-up survey. Of these, 691 patients received specialty care for pain, and 356 patients saw mental health specialists. For each patient, managed care was measured by the intensity of managed care controls in the patient's health plan and primary care office. Quality of specialty care at follow-up was measured by patient rating of care provided by the specialists. Outcomes were pain interference and bothersomeness, Symptom Checklist for Depression, and restricted activity days.ResultsThe intensity of managed care controls in health plans and primary care offices was generally not associated with patient ratings of the quality of specialty care. However, pain patients in more-managed primary care offices had lower ratings of the quality of specialty care from physician specialists and ancillary providers.ConclusionFor primary care patients with pain or depressive symptoms and who see specialists, managed care controls may influence ratings of specialty care for patients with pain but not patients with depressive symptoms.
Highlights
Managed care efforts to regulate access to specialists and reduce costs may lower quality of care
Previous U.S studies comparing the quality of care in health maintenance organizations (HMOs) and nonHMOs report mixed evidence, patient dissatisfaction is consistently greater in HMOs than in nonHMOs [5,6]
Managed care measures Based on our conceptual model of managed care [7], we identified managed care controls at two levels of health care organization, health plans and primary care offices, and created indices measuring the intensity of the managed care controls at each level
Summary
Managed care efforts to regulate access to specialists and reduce costs may lower quality of care. Few studies have examined whether managed care is associated with patient perceptions of the quality of care provided by physician and non-physician specialists. One solution is to measure the strategies, or "controls," used by health plans and medical offices to manage care, such as whether the health plan pays for care from a specialist provider only if the patient receives prior approval from the primary physician to see the specialist (known as "gatekeeping"), and if the specialist provider is a member of the health plan's provider network (known as "lock-in") [7,8]
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