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<title>Research Activities, April 1996: Primary Care/Managed Care</title>
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<p><strong>You Are Here:</strong> <span class="crumb_link"><a href="/" class="crumb_link">AHRQ Archive Home</a> &gt; <a href="/research/resarch.htm" class="crumb_link"><em>Research Activities</em> Archive</a> &gt; <a href="." class="crumb_link">April 1996</a> </span></p>
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<td><h1><a name="h1" id="h1"></a>Primary Care/Managed Care </h1>
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<td><div id="centerContent"><div class="headnote">
<p>This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: <a href="https://info.ahrq.gov/">https://info.ahrq.gov</a>. Let us know the nature of the problem, the Web address of what you want, and your contact information. </p>
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<a name="head1"></a>
<h2>Having a regular site of care but not a regular personal
physician does not adversely affect access to care</h2>
<p>Individuals who have a regular site of care, such as a health
maintenance organization (HMO), clinic, or multispecialty group
practice, use primary care services such as immunizations and
cancer screening tests as much as individuals who have a regular
personal physician, according to a recent study. This suggests
that the "impersonal care" at these sites, where a person may see
a different doctor at each visit, may not negatively affect
primary care use. However, individuals whose regular source of
care is a non-mainstream site&#8212;such as a hospital outpatient
department or emergency room, family health center, or walk-in
center&#8212;may not use primary care services as often as those
who have mainstream sites of care or regular doctors, notes
Gordon H. DeFriese, Ph.D., of the Sheps Center for Health
Services Research at the University of North Carolina at Chapel
Hill.</p><p>
The researchers, who were supported by the Agency for Health Care
Policy and Research (National Research Service Award training
grant T32 HS00032), used the 1987 National Medical Expenditure
Survey, a household survey of health care use and expenditures by
35,000 noninstitutionalized individuals, to examine patterns of
primary and preventive health care use by individuals with
regular sources of care. Analyses showed that the general use of
physician services was higher for those with a regular doctor (83
percent) than for those with a regular site but no regular doctor
(72 percent) and those with no regular source of care (65
percent).</p>
<p>However, the apparent advantage of having a regular doctor over a
regular site disappeared when only those individuals reporting a
physician's office, clinic, or HMO as their regular source of
care were compared, leaving out non-mainstream sites of care. The
researchers suggest that this difference in use of primary care
may have been caused by characteristics of the non-mainstream
sites of care as well as their inability to promote a
doctor-patient relationship.</p><p>
For details, see "The effects of having a regular doctor on
access to primary care," by Jeanne M. Lambrew, Ph.D., Dr.
DeFriese, Timothy S. Carey, M.D., M.P.H., and others, in the
February 1996 issue of <em>Medical Care</em> 34(2), pp. 138-151.
</p>
<a name="head2"></a>
<h2>Research needed on the impact of selective contracting and
freedom-of-choice laws on managed care plans</h2>
<p>Any willing provider (AWP) laws require managed care plans to
accept any qualified health care provider who is willing to
accept the terms and conditions of the plan, even though the plan
does not have to contract with all providers. Freedom of choice
(FOC) laws permit a person enrolled in a managed care plan to be
reimbursed for health care services from any qualified provider,
even if the provider has not signed a contract with the managed
care plan (selective contracting). These laws usually require
managed care plans to pay the same amount to a non-network
provider chosen by an enrollee as they pay to a network provider,
but this does not guarantee that the enrollee will incur the same
out-of-pocket costs.</p><p>
Today 33 States have passed either AWP or FOC laws, yet there is
little evidence of their impact on managed care plans, notes Fred
J. Hellinger, Ph.D., of the Agency for Health Care Policy and
Research's Center for Organization and Delivery Studies. He
discusses the effect of these laws on HMO administrative costs,
the price health plans pay to health care providers, and the use
of health services.</p>
<p>AWP and FOC laws also limit the ability of managed care plans to
funnel patients to specific providers, thus lessening their power
to obtain volume discounts. One study shows that staff- and
group-model HMOs reduced enrollees' health spending by 15 percent
compared with traditional indemnity insurance, with half of this
reduction due to price discounts.</p><p>
Dr. Hellinger notes the lack of any studies on the impact of FOC
laws and the sparse and limited nature of studies focusing on AWP
laws. He cites in particular the need for studies that compare
the experiences of health plans in States with and without
comprehensive laws. Until convincing evidence about the impact of
AWP and FOC laws on the cost and quality of care is available,
policymakers will have to rely on their own judgment when
weighing the advantages and disadvantages of this legislation,
concludes Dr. Hellinger.</p>
<p>See "Any-willing-provider and freedom-of-choice laws: An economic
assessment," by Dr. Hellinger, in the Winter 1995 issue of <em>Health Affairs</em> 14(4), pp. 297-302.</p>
<p class="size2"><a href=".">Return to Contents</a><br />
<a href="dept4.htm">Proceed to Next Article</a></p>
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<p> The information on this page is archived and provided for reference purposes only.</p></div>
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