Physician satisfaction with Medicaid managed care - The Missouri experience

BACKGROUND Medicaid managed care is important to health reform at the state level. However, little is known about physician satisfaction with these pr ograms. We sought to measure this satisfaction in Missouri and determine it s predictors. METHODS We surveyed a random sample of primary care physicians participatin g in Medicaid managed care (n = 670) or traditional Medicaid (n = 670). Pri mary outcomes measured were physicians' satisfaction with Medicaid managed care, traditional Medicaid. and commercial managed care. Satisfaction was m easured on a 5-point Likert-type scale, RESULTS The response rate was 52%. Physicians participating in Medicaid man aged care were less Likely to be satisfied or very satisfied with Medicaid managed care (28.6%) than with commercial managed care (40%) or their previ ous experience with traditional Medicaid (39.7%). Among physicians particip ating in traditional Medicaid, 29.8% a ere satisfied or very satisfied with traditional Medicaid. Physicians participating in Medicaid managed care we re less satisfied with clinical autonomy under that system in comparison wi th their previous experience with traditional Medicaid (relative difference = 10.8%, P =.001). In multiple linear regression analyses, clinic al auton omy (R-2 = 0.40) was a strong predictor of overall satisfaction with Medica id managed care, CONCLUSIONS Enhancing physicians' clinical autonomy may result in improved satisfaction with Medicaid managed care. State Medicaid agencies should inc lude physician satisfaction as a measure of Medicaid managed care plans' qu ality.