Physician participation and nonparticipation in Medicaid managed care: TheTennCare experience

Background. TennCare is a significant state health reform effort, channelin g all Medicaid recipients into managed care. We examined physician attitude s about TennCare. Methods. In 1997, we surveyed a stratified random sample of Tennessee physi cians using predominantly Likert-type scale questions. All physicians surve yed were involved in patient care and were selected from seven specialties: general practice, family practice, general internal medicine, obstetrics/g ynecology, neurosurgery, general surgery, and pediatrics. We asked about pa rticipation, satisfaction, perceptions of quality, and appropriateness of c are. Results. Major reasons for nonparticipation included bureaucracy and low co mpensation. Overall, dissatisfaction with TennCare was high (72% not at all or not very satisfied), relating to reimbursement issues and constraints o n obtaining services, particularly pharmaceuticals. More physicians (45.9%) thought quality had declined under TennCare than believed it improved (12. 6%). Conclusions. Despite strong negative opinions about TennCare, physician par ticipation is high (85.6%) because of a sense of professional responsibilit y.