THE IMPACT OF INSURANCE TYPE AND FORCED DISCONTINUITY ON THE DELIVERYOF PRIMARY-CARE

BACKGROUND. The effect of managed care on important attributes of prim ary care is poorly understood. Of particular concern is the potential for annual bidding on managed care contracts, which may cause forced d iscontinuity of care. We examined the effect of insurance type and ins urance-mandated disruption in continuity of care on the quality of pri mary care. METHODS. A cross-sectional study design was used to examine 1839 patient Visits to 138 community-based primary care physicians. T he quality of primary care delivery was measured with the Components o f Primary Care Instrument, a patient-reported indicator of physician k nowledge of the patient, interpersonal communication, coordination of care, continuity of care, and patients' preference to see their regula r physician. RESULTS. No significant differences in any of the five in dicators of primary care quality were found between patients with inde pendent provider association/preferred provider organization (IPA/PPO) and fee-for-service insurance. Patients with IPA/PPO health insurance were four times as likely as patients with fee-for-service insurance to report a forced change in their primary care physician (P less than or equal to.01). Individuals forced to change their physician because of changes in their health care insurance scored significantly lower on all five indicators of primary care quality (P less than or equal t o.01). CONCLUSIONS. The quality of primary care appears to be less dep endent on the payment system than on the maintenance of the patient-ph ysician relationship. Forced disruption of continuity of care is detri mental to patient receipt of quality primary care, and is a potential negative consequence of annual bidding for managed care contracts.