Nurseweek/Healthweek|Reductions in charity care reflect new era in managed care

Reductions in charity care reflect new era in managed care

Posted 4-5-99

Competitive managed care environments are reducing the charity care physicians provide and the institutional funding given to research, according to reports published recently in the Journal of the American Medical Association.

A national survey of 12,000 physicians and medical school faculty found that physicians who derived most of their revenue from managed care sources provided 40 percent less care to indigent patients than physicians with "very little managed care business," said Peter J. Cunningham, PhD, senior health researcher with the Center for Studying Health System Change in Washington, D.C., which is funded by The Robert Wood Johnson Foundation in Princeton, N.J.

The survey also concluded that physicians practicing in areas with high managed care penetration tended to provide less charity care. "The cost-control measures that managed care plans use exert financial and time pressures on physicians and limit their ability to shift the cost [of charity care] onto private payers," Cunningham said.

The study’s authors also found the amount of research funds medical faculty received from their academic institutions, as a proportion of total institutional funding, was twice as high in managed care markets with less competition between health plans (6.1. percent). This compared with the most competitive managed care markets where research funding was only 2.5 percent.

"Our research … suggests that market pressures may affect the availability of support for these [research] activities," wrote Joel S. Weissman, PhD, of Massachusetts General Hospital and Harvard Medical School in Boston, who wrote an article on the topic in JAMA.

In a related editorial, Robert H. Fletcher, MD, of Harvard Medical School, proposed that all healthcare payers contribute to a pool for funding teaching, research, and community service.