Physician participation and nonparticipation in Medicaid managed care: the TennCare experience.

Journal Article (Journal Article)


TennCare is a significant state health reform effort, channeling all Medicaid recipients into managed care. We examined physician attitudes about TennCare.


In 1997, we surveyed a stratified random sample of Tennessee physicians using predominantly Likert-type scale questions. All physicians surveyed were involved in patient care and were selected from seven specialties: general practice, family practice, general internal medicine, obstetrics/gynecology, neurosurgery, general surgery, and pediatrics. We asked about participation, satisfaction, perceptions of quality, and appropriateness of care.


Major reasons for nonparticipation included bureaucracy and low compensation. Overall, dissatisfaction with TennCare was high (72% not at all or not very satisfied), relating to reimbursement issues and constraints on obtaining services, particularly pharmaceuticals. More physicians (45.9%) thought quality had declined under TennCare than believed it improved (12.6%).


Despite strong negative opinions about TennCare, physician participation is high (85.6%) because of a sense of professional responsibility.

Full Text

Duke Authors

Cited Authors

  • Sloan, FA; Conover, CJ; Rankin, PJ

Published Date

  • November 1999

Published In

Volume / Issue

  • 92 / 11

Start / End Page

  • 1064 - 1070

PubMed ID

  • 10586831

Electronic International Standard Serial Number (EISSN)

  • 1541-8243

International Standard Serial Number (ISSN)

  • 0038-4348

Digital Object Identifier (DOI)

  • 10.1097/00007611-199911000-00004


  • eng