PRIMARY-CARE PHYSICIANS SATISFACTION WITH QUALITY OF CARE IN CALIFORNIA CAPITATED MEDICAL GROUPS

Context.-Managed care and capitation have placed new responsibilities on primary care physicians, including formally acting as ''gatekeepers '' for specialty services and tests. Previous studies have not examine d whether primary care physicians who provide services to patients und er many coverage arrangements feel differently about caring for patien ts covered under capitation vs those covered through more traditional forms of insurance. An understanding of whether California primary car e physicians feel that they deliver a different level of quality to ca pitated patients could help signal whether variations in care for pati ents with different coverage forms are evolving. Objective.-To evaluat e whether primary care physicians in California capitated groups repor t different satisfaction levels with quality of care for patients in t heir overall practice than for patients covered by capitated contracts and to examine whether physicians' satisfaction with capitated care q uality is influenced by the characteristics of the practice setting. D esign.-Cross-sectional questionnaire. Setting.-A total of 89 Californi a physician groups with capitated contracts. Participants.-A total of 910 primary care physicians (80% response rate). Main Outcome Measure. -Satisfaction with 4 aspects of quality of care provided to patients c overed by capitated contracts vs patients overall. Results.-Physicians reported lower satisfaction with all 4 aspects of care for patients c overed by capitated contracts than for patients in their overall pract ice: 71% were very or somewhat satisfied with relationships with capit ated patients (compared with 88% far overall practice), 64% were very or somewhat satisfied with the quality of care they provided to capita ted patients (compared with 88% for overall practice), 51% were very o r somewhat satisfied with their ability to treat capitated patients ac cording to their own best judgment (compared with 79% for overall prac tice), and 50% were very or somewhat satisfied with their ability to o btain specialty referrals (compared with 59% for overall practice) (P less than or equal to.001 for all comparisons). Being in a medical gro up practice (vs an independent practice association) and having a larg er percentage of capitated patients were independently associated by m ultivariate analysis with higher levels of satisfaction with capitated quality of care (P less than or equal to.005). Conclusion.-These Cali fornia primary care physicians were less satisfied with the quality of care they deliver to patients covered by capitated contracts than wit h the quality of care they deliver to patients covered by other paymen t sources. However, those in medical group practices and with a higher percentage of capitated patients were more satisfied with capitated c are. National expansion of capitation should be accompanied by efforts to ensure that the satisfaction of practicing physicians with the car e they deliver does not decline.