| Titre : | Selection and exclusion of primary care physicians by managed care organizations. (1998) |
| Auteurs : | A.B. BINDMAN ; K. GRUMBACH ; D. JAFFE ; D. OSMOND ; K. VRANIZAN ; Department of Medicine. University of California. San Francisco. USA ; Division of General Internal Medicine. San Francisco General Hospital. University of California. San Francisco. USA ; Primary Care Research Center. San Francisco General Hospital. University of California. San Francisco. USA |
| Type de document : | Article |
| Dans : | JAMA - Journal of the american medical association (vol. 279, n° 9, 1998) |
| Pagination : | 675-679 |
| Langues: | Anglais |
| Mots-clés : | Soins intégrés ; Médecin ; Soins santé primaire ; Sélection ; Homme ; Etats Unis ; Amérique du Nord ; Amérique |
| Résumé : | [BDSP. Notice produite par INIST R0x4fC66. Diffusion soumise à autorisation]. Context. - Little is known about the problems physicians may be encountering in gaining access to managed care networks and whether the process used by managed care plans to select physicians is discriminatory. Objective. - To investigate the incidence and predictors of denials or terminations of physicians'managed care contracts and the impact these denials and terminations had on primary care physicians'involvement with managed care. Design. - Cross-sectional mail survey of a probability sample of primary care physicians. Setting. - A total of 13 large urban counties in California. Participants. - Primary care physicians (family practice, internal medicine, obstetrics and gynecology, or pediatrics) who work in office-based practice. Main Outcome Measures. - Denial or termination from a contract with an independent practice association (IPA) or health maintenance organization (HMO) and managed care contracts. Results. - Of the 947 respondents (response rate, 71%), 520 were involved in office-based primary care. After adjusting for sampling and response rate, 22% of primary care physicians had been denied or terminated from a contract with an IPA or HMO, but 87% of office-based primary care physicians had at least 1 IPA or direct HMO contract. Solo practice was the strongest predictor of having experienced a denial or termination and of having neither an IPA nor a direct HMO contract. (...) |
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