American College of Physicians: Internal Medicine — Doctors for Adults ®

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From the June 1999 ACP-ASIM Observer, copyright 1999 by the American College of Physicians-American Society of Internal Medicine.

New studies: Managed care eroding the medical safety net

The growth of managed care appears to be straining the safety net that has traditionally provided medical care to the needy and uninsured.

According to a study from the Center for Studying Health Change, physicians whose practices derive a high proportion of their revenues from managed care provide about 40% less charity care than physicians who get less revenue from health plans. In addition, results from another study indicate that individuals in areas with high Medicaid managed care penetration are having problems getting their health care needs met.

The first study, which appeared in the March 24 issue of the Journal of the American Medical Association, found that 77% of U.S. physicians provide some charity care, with most providing about 10 hours a month. But it also found that physicians who get 85% or more of their total practice income from managed care provide about half as much charity care as those physicians with no managed care business, and about 40% less than physicians who get up to 20% of their revenue from managed care plans.

The Center's second study found that all low-income persons, including those who have insurance, were more likely to report that their health care needs were unmet in communities with high Medicaid managed care penetration than those in areas with few Medicaid HMOs. Uninsured persons were about 75% more likely to not have a usual source of health care in states with high Medicaid managed care penetration than uninsured persons in low Medicaid managed care states.

Primary care office visits on the rise for physicals, depression, diabetes

The number of primary care office visits in 1998 for routine medical exams rose to more than 13 million, an increase of more than 13%, according to figures released by Scott-Levin, a consulting firm in Newtown, Pa.

Physicians recorded nearly 10 million office visits for depression, an increase of almost 10%, while visits for diabetes mellitus—which topped 25 million—increased by more than 6%. The number of office visits declined for acute upper respiratory infection by 7.7%, for bronchitis by 6.2%, for chronic sinusitis by 6% and for otitis media by 5%.

The condition that last year resulted in the greatest number of primary care office visits—62 million—was hypertension, a 2% increase over 1997 figures.

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