PRIMARY-CARE PHYSICIANS VIEWS ON ACCESS AND HEALTH-CARE REFORM - THE SITUATION IN NORTH-CAROLINA

Background. This cross-sectional study assessed physicians' satisfacti on with the current insurance-based reimbursement system and preferenc es for the two most frequently discussed health care reform proposals, and estimated the association between demographic and practice charac teristics and attitudes toward health policy issues and reform plans. Methods. A random sample of 300 physicians was drawn from state licens ure files of general practitioners, family physicians, and pediatricia ns practicing in North Carolina. All sample physicians were sent a sch ematic outline of the two major health reform alternatives and a 1-pag e self-administered questionnaire to determine their attitudes toward the current health care system and their preferences for health reform alternatives. Results. Sixty-nine percent of physicians responded to the survey. The responses indicated dissatisfaction with the current s ystem and strong beliefs that access to care is inadequate in this div erse state with a large poor and rural population. Nearly one third of the physicians reported having insufficient information to choose bet ween plans. Among physicians expressing a preference, 37% preferred ma naged competition, 38% preferred continuing the current system, and 25 % preferred a single-payer system. Conclusions. A uniform opinion abou t health care policy is a thing of the past for American medicine. Bec ause terms used in the health reform debate (especially ''managed comp etition'') are ambiguous and set in the context of an increasingly div erse medical profession, no single direction of health reform (much le ss a specific plan) secures widespread understanding or support from a large proportion of physicians. None of the plans will please all of the doctors all of the time.