Managed care and physicians' provision of charity care

JAMA. 1999 Mar 24-31;281(12):1087-92. doi: 10.1001/jama.281.12.1087.


Context: Health system changes may be affecting the ability of physicians to provide care with little or no compensation from patients who are uninsured and under-insured and may result in decreased access to physicians for uninsured persons.

Objective: To examine the association between managed care and physicians' provision of charity care.

Design: The 1996-1997 Community Tracking Study physician survey.

Setting and participants: A nationally representative sample of 10881 physicians from 60 randomly selected communities.

Main outcome measure: The number of hours in the month prior to the interview that the physician provided care for free or at reduced fees because of the financial need of the patient.

Results: Overall, 77.3% of respondents provided an average of 10.3 hours of charity care per month [corrected]. Physicians who derive at least 85% of their practice revenue from managed care plans were considerably less likely to provide charity care and spend fewer hours providing charity care than physicians with little involvement in managed care plans (P = .01). In addition, physicians who practice in areas with high managed care penetration provided fewer hours of charity care than physicians in other areas, regardless of their own level of involvement with managed care (P<.01). Differences in charity care provision were also shown for other important factors, including ownership of the practice and practice arrangements (more charity care occurred in solo and 2-physician practices; P<.01).

Conclusion: Physicians involved with managed care plans and those who practice in areas with high managed care penetration tend to provide less charity care.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Charities / statistics & numerical data*
  • Health Care Surveys
  • Humans
  • Managed Care Programs / economics
  • Managed Care Programs / statistics & numerical data*
  • Medical Indigency / statistics & numerical data
  • Medically Uninsured / statistics & numerical data
  • Physicians / economics
  • Physicians / statistics & numerical data*
  • Practice Management / statistics & numerical data
  • Professional Autonomy
  • Regression Analysis
  • Time and Motion Studies
  • Uncompensated Care / statistics & numerical data*
  • United States