Are all health plans created equal? The physician's view.

CONTEXT: The health care market is demanding increasing amounts of information regarding quality of care in health plans. Physicians are a potentially important but infrequently used source of such information. OBJECTIVE: To assess physicians' views on health plan practices that promote or impede delivery of high-quality care in health plans and to compare ratings between plans. SETTING: Minneapolis-St Paul, Minn. PARTICIPANTS: One hundred physicians in each of 3 health plans. Each physician rated 1 health plan. MAIN OUTCOME MEASURES: Likert-type items that assessed health plan practices that promote or impede delivery of high-quality care. RESULTS: A total of 249 physicians (84%) completed the survey. Fewer than 20% of all physicians gave plans the highest rating (excellent or strongly agree) for health plan practices that promote delivery of high-quality care (such as providing continuing medical education for physicians, identifying patients needing preventive care, and providing physicians feedback about practice patterns). Barriers to delivering high-quality care related to sufficiency of time to spend with patients, covered benefits and copayment structure, and utilization management practices. Ratings differed across health plans. For example, the percentage of physicians indicating that they would recommend the plan they rated to their own family was 64% for plan 1, 92% for plan 2, and 24% for plan 3 (P<.001 for all comparisons). CONCLUSIONS: Physician surveys can highlight strengths and weaknesses in health plans, and their ratings differ across plans. Physician ratings of health plan practices that promote or impede delivery of high-quality care may be useful to consumers and purchasers of health care as a tool to evaluate health plans and promote quality improvement.

Duke Scholars

Author Christine Goertz Orthopaedic Surgery