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Nearly 50 percent of revenues collected by all physicians were from managed care organizations (MCOs) in 1999. Yet a recent study of Maryland physicians found that more black, Asian, and Hispanic physicians than white physicians had been denied managed care contracts between one and three times in the preceding 2 years. This exclusion of minority providers may compromise access to health care among minority patients who are five times more likely than white patients to have a physician from a racial/ethnic minority group, explain Keith Elder, Ph.D., M.P.H., M.P.A., of the University of South Carolina, and Nancy Miller, Ph.D., M.A., of the University of Maryland, Baltimore County. Their work was supported by the Agency for Healthcare Research and Quality (F31 HS11486).
Drs. Elder and Miller analyzed data on 1,215 ethnically diverse Maryland physicians from all specialties from the 2000 Maryland Study on Physician Experience with Managed Care Survey. They estimated the probability of a contract denial or termination as a function of physician characteristics, physician practice characteristics, and managed care market characteristics (for example, HMO penetration and number of HMOs in a region).
Contracts were denied between one and three times in the preceding 2 years for 26 percent of black physicians, 23 percent of Hispanic and Asian physicians, and 20 percent of white physicians. Contracts were terminated during that time for 14 percent of black physicians, 12 percent of Asian physicians, 10 percent of white physicians, and 8 percent of Hispanic physicians. Nevertheless, racial differences in contract denial or termination were not statistically significant.
Hispanic, black, and Asian physicians' practices were more likely to have a patient load that was more than half minority patients, who tend to use more health resources than white patients. This may explain the disparity between white and minority physicians in managed care contract denials and terminations, since previous studies have suggested that physicians whose patients require greater health care resources are more likely to be denied contracts.
See "Managed care's effect on minority physicians and their patients," by Drs. Elder and Miller, in the September 2004 Managed Care Interface 17(9), pp. 25-31.
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