Are all health plans created equal? The physician's view
S. J. Borowsky, M. K. Davis, C. Goertz and N. Lurie
Department of Medicine, Minneapolis Veterans Affairs Medical Center, MN 55417, USA.
CONTEXT: The health care market is demanding increasing amounts of
information regarding quality of care in health plans. Physicians are a
potentially important but infrequently used source of such information.
OBJECTIVE: To assess physicians' views on health plan practices that
promote or impede delivery of high-quality care in health plans and to
compare ratings between plans. SETTING: Minneapolis-St Paul, Minn.
PARTICIPANTS: One hundred physicians in each of 3 health plans. Each
physician rated 1 health plan. MAIN OUTCOME MEASURES: Likert-type items
that assessed health plan practices that promote or impede delivery of
high-quality care. RESULTS: A total of 249 physicians (84%) completed the
survey. Fewer than 20% of all physicians gave plans the highest rating
(excellent or strongly agree) for health plan practices that promote
delivery of high-quality care (such as providing continuing medical
education for physicians, identifying patients needing preventive care, and
providing physicians feedback about practice patterns). Barriers to
delivering high-quality care related to sufficiency of time to spend with
patients, covered benefits and copayment structure, and utilization
management practices. Ratings differed across health plans. For example,
the percentage of physicians indicating that they would recommend the plan
they rated to their own family was 64% for plan 1, 92% for plan 2, and 24%
for plan 3 (P<.001 for all comparisons). CONCLUSIONS: Physician surveys
can highlight strengths and weaknesses in health plans, and their ratings
differ across plans. Physician ratings of health plan practices that
promote or impede delivery of high-quality care may be useful to consumers
and purchasers of health care as a tool to evaluate health plans and
promote quality improvement.
Physicians' Perceptions of Managed Care: A Review of the Literature
Christianson et al.
Med Care Res Rev 2005;62:635-675.
ABSTRACT
Breast and Cervical Cancer Screening: Clinicians' Views on Health Plan Guidelines and Implementation Efforts
Zapka et al.
J Natl Cancer Inst Monogr 2005;2005:46-54.
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Chaudry et al.
Qual Health Res 2003;13:37-56.
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Smith et al.
Eval Health Prof 2001;24:18-35.
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Weil
American Journal of Medical Quality 2001;16:23-33.
ABSTRACT
Quality of Care in Investor-Owned vs Not-for-Profit HMOs
Himmelstein et al.
JAMA 1999;282:159-163.
ABSTRACT
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Rolling Down the Runway: The Challenges Ahead for Quality Report Cards
Epstein
JAMA 1998;279:1691-1696.
ABSTRACT
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Physicians' Ratings of Health Plans
Allen et al.
JAMA 1998;279:193-194.
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Physicians Rate Health Plans
Journal Watch Dermatology 1997;1997:20-20.
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PHYSICIANS RATE HEALTH PLANS
JWatch General 1997;1997:5-5.
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