Managed care and capitation in California: how do physicians at financial risk control their own utilization?

Article Abstract:

More physician groups may be initiating their own internal cost-containment programs in response to the trend towards managed care. Researchers polled 46 independent medical associations and 48 medical group practices in California to characterize the ways in which the practices internally control costs. All of the practices required patients to first seek medical attention from their primary physician. Most practices required the primary physician's referral or preauthorization for further testing or evaluation depending on the type of specialty. Most groups (89%) had a committee in place to review referrals. These committees denied fewer than 10% of requests for expensive tests or procedures. Many practices also provided yearly reports to each physician itemizing the number and kind of referrals the doctor made, amounts of drugs prescribed, and hospitalization rates for their patients. Most groups made cost-management decisions on a case-by-case basis rather than rely on written guidelines.

Management, Economic aspects, Health maintenance organizations, Group medical practice

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Quality-of-life outcomes in men treated for localized prostate cancer

Article Abstract:

Men who are treated for prostate cancer may have a similar overall health-related quality of life (HRQOL) as other men, even though prostate cancer patients may have poorer sexual, bowel, and urinary function. Researchers surveyed 214 men treated for prostate cancer and 273 men without prostate cancer to assess the men's HRQOL. Of those with prostate cancer, 98 men underwent removal of the prostate gland, 56 had radiation therapy, and 60 were under observation. General HRQOL was similar among men in the three cancer treatment groups and the other men. Men with prostate cancer, particularly those who had surgery or radiation, had poorer sexual function than other men. Surgically-treated cancer patients had poorer urinary function than other subgroups of cancer patients and men without cancer. Bowel functioning was similar in all subgroups of cancer patients and between cancer patients as a whole and men without cancer.

Health aspects, Evaluation, Complications and side effects, Prostate cancer, Quality of life, Cancer patients

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Primary care physicians' satisfaction with quality of care in California capitated medical groups

Article Abstract:

Primary care physicians in California are not completely satisfied with the care they give their patients who are covered by a managed care plan. Researchers surveyed 910 primary care physicians in 89 California physician practice groups. They were rated on their satisfaction with four aspects of care: their relationship with the patient, the quality of care they provided, their ability to use their judgment in selecting treatments and their ability to refer to specialists. On every measure, physicians were less likely to be satisfied with the care provided to managed care patients compared to fee-for-service patients.

Psychological aspects, Physicians, Surveys, Job satisfaction, Quality of work life

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