BUSINESS

Autonomy gains offset by less time for patients

A managed care survey released by the Center for Studying Health System Change gets mixed reviews.

By Robert Kazel, AMNews staff. Feb. 3, 2003.

Changes in managed care have brought greater independence in treating patients, primary care physicians and specialists say. But there's just not enough time to spend with those patients.

That's the mixed review of the managed care environment from a nationwide survey of 12,000 physicians by the Washington, D.C.-based Center for Studying Health System Change.

The proportion of specialists who think they have "the freedom to make clinical decisions" rose from 72.7% in 1997 to 85.7% in 2001, according to the survey, released in January.

The change seems to reflect the gradual dropping of gatekeeping rules, as well as fewer requirements for prior authorizations for tests and procedures, said J. Lee Hargraves, PhD, lead author of the study, "Back In the Driver's Seat: Specialists Regaining Autonomy."

The power of specialists to stand up to the authority of health plans appears to be on the rise, Dr. Hargraves said.

Researchers cite "a remarkable ability of specialists to organize and band together through larger group practices to get more leverage."

Clifford Bassett, MD, an allergist in New York, said the survey reflects specialists' satisfaction that large health plans are abandoning unnecessarily complex referral mechanisms. "The members are happy. The doctors' offices are happier because there is less paperwork to do. It's a win-win for everyone."

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