Thomas Williams

Thomas Williams

Senior Fellow, Health Care Division, NORC at The University of Chicago

Dissertation Title: "Physician Experiences and Evaluations of Managed Care Organizations: Perceived Organizational Support in Health Care"Physicians are increasingly working in managed care organizations. At the same time these organizations apply some combination of regulatory, financial, or normative mechanisms to influence clinical decisions of physicians within them. The outcome of this management on the job attitudes of physicians is most important for its effect on the core content of their work. Physician satisfaction with managed care plans and their recommendations of it to others may indicate a high level of support to quality of care and management that allows independent judgement and clinical freedoms to treat in ways they view as appropriate.

The first empirical study of this thesis asked physicians to evaluate the resources and procedures of one of the managed care plans they worked with and to assess the extent to which the management strategies used by that plan influence their clinical behavior and the quality of care available to their patients. Physicians said that use of education and peer influence as management strategies had greater influence over their clinical behavior and facilitated the provision of high quality care more than the use of rules and regulations or financial incentives. Plans with the most positive evaluations were plans that physicians said used educational strategies more and that used rules and regulations and financial incentives less.

The second empirical study of this thesis investigates the association of participation in more than one managed care organization and reported autonomy. The increasing participation of physicians in managed care has led to increasing involvement in managed care plans and greater numbers of managed care contracts. It was felt that complexity of managing more than one health care contract would compound the administrative burden of patient care and practice management. The second study did not indicate an association between autonomy and participation for the sample of physicians. It did establish the important nature of organizational support to essential features of a physician's task environment. The number of denials and lower reports of administrative support were strong predictors of lower reports of clinical autonomy.


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