Blaming Physicians Who Do Not Contract With Managed Care

The Center for Health System Changed just released a tracking report (available here) on physicians' relationships with managed care networks. The most important findings were that there has been a relatively large increase in the small numbers of physicians who do not contract with any managed care organization (MCO), from 9.2% of physicians in 2000-1 to 11.5% in 2004-5, or get no revenue from any MCO, from 5.8% to 8.6%.

How the press release from the Center summarized these findings is instructive. It quoted Paul B Ginsburg, President of the Center:

While physicians have not dropped out of managed care networks in large numbers, this small but statistically significant increase could signal a trend toward greater out-of-pocket costs for patients and a decline in patient access to physicians.

Note that this quote managed to suggest two things:

• That physicians, not managed care organizations, were responsible for the problem.
• That physicians' actions would increase costs and decrease access.

Excuse me? Just as good an explanation is that a small but increasing number of physicians can no longer tolerate working with contemporary managed care. In fact, the full report is more balanced, mentioning "physicians are frustrated by costly and time-consuming administrative burdens and low payment rates associated with health insurance contracts...." It also acknowledged that the effects of this pheonomenon on cost and access may be complex, and in fact could improve access for some patients involved.
Perusal of Health Care Renewal will reveal that managed care organizations, like other large health care organizations, are beset by problems that go far beyond bureaucracy and low reimbursement rates. Some of our more recent posts on Health Care Renewal have featured how:

• Kaiser Permanente mismanged the initiation of its kidney transplant program (here)
• WellPoint in California allegedly had a unit which retroactively denied patients coverage if they made mistakes on their applications form (here)
• UnitedHealth gave its CEO a cache of stock options now worth a staggering $1.6 billion, while its mission proclaims its support of "affordable health care" (here), while UnitedHealth's board of directors include academics with potentially major conflicts of interest (here and here)
• Many US urban health care markets have become dominated by one or a few managed care organizations or insurance companies (here)

Such problems, and many others reported earlier on Health Care Renewal, and extensively in the early literature on managed care, suggest that managed care may in fact bear responsibility for increased costs, decreased access, and stagnant quality in US health care.
So perhaps it is not irrational, nor dishonorable for some physicians to want to back away from relationships with managed care organizations.
Yet too often the health services research and health policy literature seems quick to blame physicians for problems, and reluctant to assign any responsibility to large health care organizations, such as managed care organizations, and their leaders.