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Peter J. Cunningham, PhD; Joy M. Grossman, PhD; Robert F. St. Peter, MD; Cara S. Lesser, MPP

JAMA. 1999;281:1087-1092.

Context  Health system changes may be affecting the ability of physicians to provide care with little or no compensation from patients who are uninsured and underinsured and may result in decreased access to physicians for uninsured persons.

Objective  To examine the association between managed care and physicians' provision of charity care.

Design  The 1996-1997 Community Tracking Study physician survey.

Setting and Participants  A nationally representative sample of 10,881 physicians from 60 randomly selected communities.

Main Outcome Measure  The number of hours in the month prior to the interview that the physician provided care for free or at reduced fees because of the financial need of the patient.

Results  Overall, 77.3% of respondents provided an average of 10.3 hours of charity care per week. Physicians who derive at least 85% of their practice revenue from managed care plans were considerably less likely to provide charity care and spend fewer hours providing charity care than physicians with little involvement in managed care plans (P=.01). In addition, physicians who practice in areas with high managed care penetration provided fewer hours of charity care than physicians in other areas, regardless of their own level of involvement with managed care (P<.01). Differences in charity care provision were also shown for other important factors, including ownership of the practice and practice arrangements (more charity care occurred in solo and 2-physician practices; P<.01).

Conclusion  Physicians involved with managed care plans and those who practice in areas with high managed care penetration tend to provide less charity care.

Author Affiliations: Center for Studying Health System Change, Washington, DC (Drs Cunningham and Grossman and Ms Lesser), and Kansas Health Institute, Topeka (Dr St. Peter).

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