Providing Insights that Contribute to Better Health Policy
Insurance Coverage & Costs Access to Care Quality & Care Delivery Health Care Markets Issue Briefs Data Bulletins Research Briefs Policy Analyses Community Reports Journal Articles Other Publications Surveys Site Visits Design and Methods Data Files
Proportion of U.S. Physicians Without Any Managed Care Contracts Ticks Up
No Physician Exodus from Managed Care Networks, But Trend Could Portend Greater Cost and Access Problems for Patients
FURTHER INFORMATION, CONTACT:
Compared with physicians with one or more managed care contracts, physicians without managed care contracts are more likely to have practiced for more than 20 years, work part time, lack board certification, practice solo or in two-physician groups, and live in the western United States, the study found.
"While physicians have not dropped out of managed care networks in large numbers, this small but statistically significant increase could signal a trend toward greater out-of-pocket costs for patients and a decline in patient access to physicians," said Paul B. Ginsburg, Ph.D., president of HSC, a nonpartisan policy research organization funded principally by The Robert Wood Johnson Foundation.
Options for physicians who do not contract with managed care plans range from seeing only patients covered by insurance products that do not include provider networks (including fee-for-service Medicare), establishing cash-only practices, and serving managed care patients as an out-of-network provider who can balance bill patients for charges beyond insurer reimbursements for out-of-network providers.
"Despite media reports about doctors dropping out of insurance networks because of payment and administrative hassles, the vast majority of physicians continue to contract with managed care plans," said HSC Senior Researcher Ann S. OMalley, M.D., coauthor of the study with HSC Senior Researcher James D. Reschovsky, Ph.D.
Growth in the percentage of physicians without any managed care contracts may reflect fewer privately insured patients enrolled in health maintenance organizations (HMO) that do not pay for care received from out-of-network providers. At the same time, enrollment in plans that pay some cost of out-of-network carepreferred provider organizations (PPOs) and point of service (POS) plansgrew 13 percentage points between 2000 and 2005, according to the Kaiser Family Foundation. In 2005, more than three-quarters of people with employer health coverage were enrolled in a PPO or POS plan.
Based on HSCs nationally representative Community Tracking Study Physician Survey, the studys findings are detailed in a new HSC Tracking ReportNo Exodus: Physicians and Managed Care Networksavailable here. The 1996-97, 1998-99, 2000-01 surveys contain information on about 12,000 physicians, and the 2004-05 survey includes responses from more than 6,600 physicians. Response rates for the surveys range from 52 percent to 65 percent.
The study also found substantial variation in the proportion of physicians without managed care contracts across communities, suggesting that local market conditions influence decisions to contract with managed care plans.
Other key study findings include:
The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nations changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded principally by The Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research, Inc.