Does managed care restrictiveness affect the perceived quality of primary care? A report from ASPN

Susan A. Flocke, A. John Orzano, H. Andrew Selinger, James J. Werner, Laurie Vorel, Paul A. Nutting, Kurt C. Stange

Research output: Contribution to journalArticlepeer-review

24 Scopus citations


BACKGROUND. The competitive managed care marketplace is causing increased restrictiveness in the structure of health plans. The effect of plan restrictiveness on the delivery of primary care is unknown. Our purpose was to examine the association of the organizational and financial restrictiveness of managed care plans with important elements of primary care, the patient-clinician relationship, and patient satisfaction. METHODS. We conducted a cross-sectional study of 15 member practices of the Ambulatory Sentinel Practice Network selected to represent diverse health care markets. Each practice completed a Managed Care Survey to characterize the degree of organizational and financial restrictiveness for each individual health care plan. A total of 199 managed care plans were characterized. Then, 1475 consecutive outpatients completed a patient survey that included: the Components of Primary Care Instrument as a measure of attributes of primary care; a measure of the amount of inconvenience involved with using the health care plan; and the Medical Outcomes Study Visit Rating Form for assessing patient satisfaction. RESULTS. Clinicians' reports of inconvenience were significantly associated (P <.001) with the financial and organizational restrictiveness scores of the plan. There was no association between plan restrictiveness and patient report of multiple aspects of the delivery of primary care or patient satisfaction with the visit. CONCLUSIONS. Plan restrictiveness is associated with greater perceived hassle for clinicians but not for patients. Plan restrictiveness seems to be creating great pressures for clinicians, but is not affecting patients' reports of the quality of important attributes of primary care or satisfaction with the visit. Physicians and their staffs appear to be buffering patients from the potentially negative effects of plan restrictiveness.

Original languageEnglish (US)
Pages (from-to)762-768
Number of pages7
JournalJournal of Family Practice
Issue number10
StatePublished - 1999
Externally publishedYes


  • Family practice
  • Managed care programs
  • Patient satisfaction
  • Physicians' role
  • Practice management
  • Primary health care

ASJC Scopus subject areas

  • Family Practice


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