Attitudes of Washington State primary care physicians toward capitation-based insurance plans

Recent years have brought many changes in health care financing, including health care insurance plans based on capitation allowances to physicians. This study describes a survey examining physician attitudes toward such plans. The survey was distributed to a random sample of 30% of the family physicians, general practitioners, general internists, and general pediatricians in the Washington State Medical Association in 1986. Responses from 322 physicians (71%) indicated that most primary care physicians had a negative attitude toward such plans. Participants in capitation-based plans (48% of total respondents) had a nearly neutral attitude, which was significantly different from the attitude of nonparticipants. Respondents identified the main disadvantages of such plans as confusion about benefits, increased administrative demands, liability risks, altered professional relationships, and loss of autonomy. The main advantages perceived were increased physician awareness of cost, increased importance of the primary care role, and reduction of unnecessary health care utilization. Attitudes were significantly more negative among solo practitioners and physicians with more years in practice. Respondents rated selection of consultants, favorable economic arrangements, and benefits information as the features most likely to influence them to participate in capitation-based plans.