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Previous Volume 340:928-936 March 25, 1999 Number 12 Next

	Full Text PDF Editorial by Michels, R. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background and Methods Views of managed care among academic physicians and medical students in the United States are not well known. In 1997, we conducted a telephone survey of a national sample of medical students (506 respondents), residents (494), faculty members (728), department chairs (186), directors of residency training in internal medicine and pediatrics (143), and deans (105) at U.S. medical schools to determine their experiences in and perspectives on managed care. The overall rate of response was 80.1 percent.

Results Respondents rated their attitudes toward managed care on a 0-to-10 scale, with 0 defined as "as negative as possible" and 10 as "as positive as possible." The expressed attitudes toward managed care were negative, ranging from a low mean (±SD) score of 3.9±1.7 for residents to a high of 5.0±1.3 for deans. When asked about specific aspects of care, fee-for-service medicine was rated better than managed care in terms of access (by 80.2 percent of respondents), minimizing ethical conflicts (74.8 percent), and the quality of the doctor–patient relationship (70.6 percent). With respect to the continuity of care, 52.0 percent of respondents preferred fee-for-service medicine, and 29.3 percent preferred managed care. For care at the end of life, 49.1 percent preferred fee-for-service medicine, and 20.5 percent preferred managed care. With respect to care for patients with chronic illness, 41.8 percent preferred fee-for-service care, and 30.8 percent preferred managed care. Faculty members, residency-training directors, and department chairs responded that managed care had reduced the time they had available for research (63.1 percent agreed) and teaching (58.9 percent) and had reduced their income (55.8 percent). Overall, 46.6 percent of faculty members, 26.7 percent of residency-training directors, and 42.7 percent of department chairs reported that the message they delivered to students about managed care was negative.

Conclusions Negative views of managed care are widespread among medical students, residents, faculty members, and medical school deans.

Source Information

From the Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston (S.R.S., A.M.S., N.C.-C., M.T.C., A.S.P., T.S.I., S.D.B.); the Division of General Pediatrics, Children's Hospital, Boston (R.J.D.P.); the Division of Psychiatry, Brigham and Women's Hospital, Boston (S.D.B.); and the Graduate School of Education, Harvard University, Cambridge, Mass. (J.D.S.).

Address reprint requests to Dr. Simon at the Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, 126 Brookline Ave., Suite 200, Boston, MA 02215.

Full Text of this Article

Related Letters:

Views of Managed Care
Brett A. S., Norman G. K., Scherger J. E., Wald P. S., Brody M. R., David D. S., Simon S. R., Pan R. J.D., Block S. D., Michels R.
Extract | Full Text  
N Engl J Med 1999; 341:616-618, Aug 19, 1999. Correspondence

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