Does managed care restrictiveness affect the perceived quality of primary care? A report from ASPN

BACKGROUND. The competitive managed care marketplace is causing increased r estrictiveness in the structure of health plans. The effect of plan restric tiveness on the delivery of primary care is unknown. Our purpose was to exa mine the association of the organizational and financial restrictiveness of managed care plans with important elements of primary care, the patient-cl inician relationship, and patient satisfaction. METHODS. We conducted a cross-sectional study of 15 member practices of the Ambulatory Sentinel Practice Network selected to represent diverse health care markets. Each practice completed a Managed Care Survey to characterize the degree of organizational and financial restrictiveness for each indivi dual health care plan. A total of 199 managed care plans were characterized . Then, 1475 consecutive outpatients completed a patient survey that includ ed: the Components of Primary Care instrument as a measure of attributes of primary care; a measure of the amount of inconvenience involved with using the health care plan; and the Medical Outcomes Study Visit Rating Form for assessing patient satisfaction. RESULTS. Clinicians' reports of inconvenience were significantly associated (P <.001) with the financial and organizational restrictiveness scores of the plan. There was no association between plan restrictiveness and patient report of multiple aspects of the delivery of primary care or patient sati sfaction with the visit, CONCLUSIONS. Plan restrictiveness is associated with greater perceived hass le for clinicians but not for patients. Plan restrictiveness seems to be cr eating great pressures for clinicians, but is not affecting patients' repor ts of the quality of important attributes of primary care or satisfaction w ith the visit, Physicians and their staffs appear to be buffering patients from the potentially negative effects of plan restrictiveness.