Sick of managed care? You’re not alone

Studies show doctors are fed up

Two recent studies confirm what you’ve probably known all along — America’s doctors are fed up with managed care and feel that it has adversely affected the way they practice medicine.

Physician hostility to the health care system and managed care has reached an all-time high, according to an annual study by Strategic Health Perspectives, an alliance of the Harvard School of Public Health, Harris Interactive, health care futurist Ian Morrison in Menlo Park, CA, and Bill Rosenberg, director of Pricewaterhouse-Coopers in New York City.

At the same time, evidence shows that managed care has impaired the doctor-patient relationship, according to a different study conducted by the Medical College of Wisconsin’s Center for the Study of Bioethics.

Consider these statistics from the two studies:

Fully 83% of physicians polled by Strategic Health Perspectives believe that "fundamental changes" need to be made in the nation’s health care system or that the system needs to be completely rebuilt (11%). This compares with 51% who felt that way in 1984 and 67% in 1997.

Only 10% of physicians and 43% of the American public believe that managed care has improved the quality of care. This contrasts sharply with 57% of employers and 86% of health plans that feel managed care has succeeded in improving care.

Three-fourths of physicians responding to the Medical College of Wisconsin study said that managed care organizations influenced their ability to order diagnostic tests at least occasionally. Half of the respondents reported that they have changed their clinical behavior since they have begun participating in managed care.

About 65% of physicians reported authorization denials for tests and treatments were "never" or only "occasionally" reversed.

Only about 44% of physicians and 40% of the American public agree that managed care has been at least somewhat successful in containing costs.

Health care experiencing a sea change’

"There is a sea change in American health care. No longer are doctors happy and their patient disgruntled; now physicians are as unhappy as their patients," says Morrison. A comparison of data from the early 1990s and 1999 shows how managed care has changed the political map and produced new alliances, he adds.

For instance, in the early 1990s and during the debate of the Clinton health care proposal, most employers and most of the public wanted to change the health care system. At that time, physicians were happy and saw the government and not private health insurance and managed care as the enemy, the study shows.

In 1995, 79% of the public believed the health care system needed changing or rebuilding, compared to only 57% of physicians.

The Center for Bioethics study was the result of an eight-page survey of 2,711 physicians who were licensed in Wisconsin in 1995.

The study, led by Robyn Shapiro, JD, director and professor of Bioethics, was designed to analyze the prevalence and type of managed care arrangements and to find out what impact the arrangements have on physicians and their relationship with patients.

"Over the past several years, there have been frequent anecdotal reports about managed care’s effect on health care delivery, but little data had been collected or analyzed. While some of our findings regarding the impact of managed care were predictable, the degree to which managed care has changed physicians’ practices was something surprising," Shapiro says.

The researchers concluded that under managed care:

• Physicians have a greater likelihood to discharge patients prior to full recovery.

• Physicians now have a greater reluctance to make treatment decisions regardless of cost.

• Physicians now have a greater reluctance to refer patients to specialists or emergency departments.

• Physicians now have a greater reluctance to spend a comfortable amount of time with patients.