Examining American Family Medicine in the New World Order

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Original Research

Examining American Family Medicine in the New World Order

J Fam Pract. 1999 August;48(8):620-627

References

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The changes engendered by managed care may well lead patients to doubt the motives of their health care providers and the quality and cost of what they provide.³³ Although it is too early to assess the long-term impact of many of the changes, there is already evidence that this may be happening.^34-36

Limitations

The limitations of this study are numerous, primarily because of the qualitative nature of the research and the limited number of study sites. Generalizability is further compromised by the clear regional variations. Nonetheless, this research and others like it may help shift the debate regarding choices in the structure of health care delivery from that of free-market competition between commercial products to one concerned with the impact on patients and providers. As Eisenberg³⁷ has recently noted, “The personal equation remains at the center of medicine; the patient-doctor relationship is the linchpin of medical care.”

This study presents a rather discouraging snapshot of the American family practice. Much of the blame for the current situation is placed on managed care organizations, but the genesis of many of the problematic processes was unrelated to managed care. In addition, some of the negativity may be transitory, since the studied regional managed care markets are still in an immature state and there is some evidence that physician satisfaction increases with market maturation.38 Multiple solutions have been formulated for preserving the physician-patient relationship or forging a new model.3,24,39,40 Given the importance of the issues and the paucity of data, more empirical and observational studies are critical. Further studies can not only document the fundamental changes taking place: they can also provide the building blocks for future solutions.

· Acknowledgments ·

This research was supported by a Health Sciences grant from Ben-Gurion University of the Negev. The following qualitative and health service researchers reviewed the methods, findings, and early drafts of the manuscript at several stages: professors Arthur Kleinman, Leon Eisenberg, Rashi Fein, William Miller, Diana Shye, and Donald Freeborn; and the Visiting Scholars (1997-1998) at Harvard University, Department of Social Medicine. The author is indebted to them for their suggestions and encouragement, as well as to the providers and staffs at the 5 study centers, for their dedication to their patients and to each other, and for their support in this resear