Why do German physicians reject managed care?

Area of Science:

• Health Services Research
• Health Economics
• Physician Behavior Studies

Background:

• Managed care (MC) in Germany faces backlash 20 years post-launch, with negative perceptions among physicians and patients.
• Factors influencing physician rejection of MC contracts remain understudied.

Purpose of the Study:

• To quantitatively model physician characteristics influencing MC contract rejection.
• To inform policy measures for enhancing physician acceptance of MC.

Main Methods:

• Survey of 500 practicing physicians in Northern Germany.
• Econometric analysis using a Heckman approach to address preselection bias.
• Qualitative analysis of physician free-text responses.

Main Results:

• Higher private patient share, older physician age, and larger practice size increase MC rejection probability.
• Rural practice location is associated with decreased rejection probability.
• Key qualitative reasons for refusal include administrative burden and loss of professional autonomy.

Conclusions:

• Current health policies promoting MC through institutional measures may be less effective than addressing physician preferences.
• Physician preferences represent a significant bottleneck in managed care development.
• Policy interventions should consider physician-specific factors to foster MC acceptance.