Context.— Little is known about the problems physicians may be encountering in
gaining access to managed care networks and whether the process used by managed
care plans to select physicians is discriminatory.
Objective.— To investigate the incidence and predictors of denials or terminations
of physicians' managed care contracts and the impact these denials and terminations
had on primary care physicians' involvement with managed care.
Design.— Cross-sectional mail survey of a probability sample of primary care
Setting.— A total of 13 large urban counties in California.
Participants.— Primary care physicians (family practice, internal medicine, obstetrics
and gynecology, or pediatrics) who work in office-based practice.
Main Outcome Measures.— Denial or termination from a contract with an independent practice association
(IPA) or health maintenance organization (HMO) and managed care contracts.
Results.— Of the 947 respondents (response rate, 71%), 520 were involved in office-based
primary care. After adjusting for sampling and response rate, 22% of primary
care physicians had been denied or terminated from a contract with an IPA
or HMO, but 87% of office-based primary care physicians had at least 1 IPA
or direct HMO contract. Solo practice was the strongest predictor of having
experienced a denial or termination and of having neither an IPA nor a direct
HMO contract. Physician age, sex, and race did not predict the level of involvement
with managed care. However, physicians' patient demographics were associated
with managed care participation; physicians in managed care had significantly
lower percentages of uninsured and nonwhite patients in their practices. Physicians
experiencing a denial or termination had fewer capitated patients in their
Conclusions.— Denials and terminations, although relatively common, do not preclude
most primary care physicians from participating in managed care. Managed care
selective contracting does not appear to be systematically discriminatory
based on physician characteristics, but it may be biased against physicians
who provide greater amounts of care to the underserved.