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Physician participation and nonparticipation in Medicaid managed care: the TennCare experience
F A Sloan1, C J Conover, P J Rankin
1Center for Health Policy, Law and Management, Department of Economics, and Fuqua School of Business, Terry Sanford Institute of Public Policy, Duke University, Durham, NC 27708, USA.
Background:
TennCare is a significant state health reform effort, channeling all Medicaid recipients into managed care. We examined physician attitudes about TennCare.
Methods:
In 1997, we surveyed a stratified random sample of Tennessee physicians using predominantly Likert-type scale questions. All physicians surveyed were involved in patient care and were selected from seven specialties: general practice, family practice, general internal medicine, obstetrics/gynecology, neurosurgery, general surgery, and pediatrics. We asked about participation, satisfaction, perceptions of quality, and appropriateness of care.
Results:
Major reasons for nonparticipation included bureaucracy and low compensation. Overall, dissatisfaction with TennCare was high (72% not at all or not very satisfied), relating to reimbursement issues and constraints on obtaining services, particularly pharmaceuticals. More physicians (45.9%) thought quality had declined under TennCare than believed it improved (12.6%).
Conclusions:
Despite strong negative opinions about TennCare, physician participation is high (85.6%) because of a sense of professional responsibility.