EFFECTS OF MANAGED CARE ON PHYSICIAN-PATIENT RELATIONSHIPS, QUALITY OF CARE, AND THE ETHICAL PRACTICE OF MEDICINE - A PHYSICIAN SURVEY

Background: Survey studies have shown that physicians believe managed care is having significant impact on many of their professional obliga tions. Methods: Primary care physicians were asked about the impact of managed care on: (1) physician-patient relationships, (2) the ability of physicians to carry out their professional ethical obligations, an d (3) quality of patient care. In 1996 we surveyed 1011 primary care p hysicians in Pennsylvania. The sun ey group's responses were graded on a Likert scale. Space was provided for respondents to include written comments. The SPSS statistical software (SPSS Inc, Chicago, Ill) was used to analyze the data. Results: The response rate was 55%. Most res pondents indicated that under managed care physicians are less able to avoid conflicts of interest and less able to place the best interests of patients first. The majority responded that quality of health care is compromised by limitations in location of diagnostic tests, length of hospital stay, and choice of specialists. A significant minority ( 27%-49%) noted a decrease in the physician's ability to carry out ethi cal obligations, to respect patient autonomy, and to respect confident iality in physician-patient communication. Most physicians expressed t hat managed care made no impact on ability to obtain informed consent or to provide information. There were small but statistically signific ant sex differences, with female physicians more negative toward manag ed care. Conclusions: Many physicians sun,eyed believe managed care ha s significant negative effects on the physician-patient relationship, the ability to carry out ethical obligations, and on quality of patien t care. These results have implications for health care system reform efforts.