Primary care physicians' satisfaction with quality of care in California capitated medical groups
E. A. Kerr, R. D. Hays, B. S. Mittman, A. L. Siu, B. Leake and R. H. Brook
Center for Practice Management and Outcomes Research, Veterans Affairs Medical Center, and the Department of Medicine, University of Michigan, Ann Arbor, USA.
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 examined whether
primary care physicians who provide services to patients under many
coverage arrangements feel differently about caring for patients covered
under capitation vs those covered through more traditional forms of
insurance. An understanding of whether California primary care physicians
feel that they deliver a different level of quality to capitated patients
could help signal whether variations in care for patients with different
coverage forms are evolving. OBJECTIVE: To evaluate whether primary care
physicians in California capitated groups report different satisfaction
levels with quality of care for patients in their overall practice than for
patients covered by capitated contracts and to examine whether physicians'
satisfaction with capitated care quality is influenced by the
characteristics of the practice setting. DESIGN: Cross-sectional
questionnaire. SETTING: A total of 89 California 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 covered by capitated contracts vs
patients overall. RESULTS: Physicians reported lower satisfaction with all
4 aspects of care for patients covered by capitated contracts than for
patients in their overall practice: 71% were very or somewhat satisfied
with relationships with capitated patients (compared with 88% for overall
practice), 64% were very or somewhat satisfied with the quality of care
they provided to capitated patients (compared with 88% for overall
practice), 51% were very or somewhat satisfied with their ability to treat
capitated patients according to their own best judgment (compared with 79%
for overall practice), and 50% were very or somewhat satisfied with their
ability to obtain specialty referrals (compared with 59% for overall
practice) (P< or =.001 for all comparisons). Being in a medical group
practice (vs an independent practice association) and having a larger
percentage of capitated patients were independently associated by
multivariate analysis with higher levels of satisfaction with capitated
quality of care (P< or =.005). CONCLUSION: These California primary care
physicians were less satisfied with the quality of care they deliver to
patients covered by capitated contracts than with the quality of care they
deliver to patients covered by other payment sources. However, those in
medical group practices and with a higher percentage of capitated patients
were more satisfied with capitated care. National expansion of capitation
should be accompanied by efforts to ensure that the satisfaction of
practicing physicians with the care they deliver does not decline.
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