The impact of managed care on physicians

Area of Science:

• Health Services Research
• Healthcare Management
• Medical Economics

Background:

• Managed care emerged due to pressures on healthcare costs and delivery.
• Key models include traditional indemnity with utilization review and Health Maintenance Organizations (HMOs).

Purpose of the Study:

• To examine the driving forces behind managed care.
• To discuss physician strategies for navigating managed care.
• To analyze the current and future state of physician participation in managed care.

Main Methods:

• Review of managed care models (indemnity, HMO).
• Analysis of physician strategies within managed care frameworks.
• Examination of the evolutionary phases of managed care.

Main Results:

• Managed care encompasses utilization review and controlled access/reimbursement.
• Physicians can adopt strategies to manage managed care.
• Current phase involves data-driven selective contracting, identifying efficient physicians.

Conclusions:

• The evolution of managed care is progressing towards selective contracting based on performance data.
• Physicians identified as efficient are likely to secure contracts.
• A significant number of physicians may face unemployment due to this selective process.