A concern has been growing over the prevailing chaos in the US health care system that makes primary care physicians prime targets for urban managed care recruiters. This study examines the impact of managed care on the geographical distribution of General/Family Practice physicians (GFs) and other primary care physicians (General Internal Medicines, General Pediatrics, and General OB/Gyn). Using both the 2000 and 1994 Area Resource File, we found that the geographical distribution of GFs, "rural doctors", worsened during the managed care period. Average annual growth rate of the ratio of urban supply to rural supply for GFs in 1982-1990 is smaller (0.01) than 1990-1998 (0.09), indicating the worsening in the geographical distribution of GFs during the managed care period. Decreases in GF supply in completely rural counties during the managed care period were found even for the states with increases in the overall supply of GFs. However, this loss of GFs was somewhat offset by an increase in supply of other primary care physicians in completely rural counties. Importantly, the states that showed relative success in increasing the supply of other primary care physicians in rural areas also established comprehensive Medicaid managed care (MMC) demonstration program, expanding MMC into remote rural areas. The presence of managed care or anticipation of managed care in rural areas contributed to relative success in reducing the urban-rural differential for overall primary care physicians. States may need to expand MMC into more rural areas to improve the geographical distribution of primary care physicians.
Learning Objectives: 1. Assess the impact of managed care on the geographical distribution of primary care physicians. 2. Identify the states that showed relative success in reducing the urban-rural growth rate differential for primary care physicians. 3. Compare the trend of the geographical distribution of the supply of primary care physicians between the “managed care” period and the “prior to managed care” period.
Keywords: Rural Health Service Providers, Managed Care
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.