Women's access to appropriate providers within managed care: Implications for the quality of primary care

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      Women receive care for common acute and chronic illnesses from family physicians/general practitioners and internists and preventive care and reproductive-related care from gynecologists. In addressing the issue of appropriate providers, then, current information about use and practice variation would suggest that many women require an arrangement that offers access to a family physician and/or internist as well as a gynecologist to receive a full complement of care. In fact, those women respondents in the Commonwealth Fund Survey of Women's Health who saw both a family physician/general practitioner or internist and an obstetrician/gynecologist for regular care were most likely to receive more preventive services.4 However, although this arrangement increases a women's potential to receive comprehensive care, it reduces opportunities for continuous and coordinated care.
      A reliance upon more than one physician throughout a woman's life to deliver both preventive care and therapeutic care is not compatible with existing models of primary care and may be problematic in managed care arrangements that require women to use specific providers. In addition, requiring more than one physician to obtain the majority of one's health care services is likely to result in increased direct and opportunity costs. Women without adequate insurance or financial resources may be unable to seek care from one, let alone two, physicians and therefore may be at higher risk of not receiving needed or necessary care.
      Nonetheless, women are satisfied with a dual arrangement and articulate strong preferences for maintaining access to gynecologists and to family physicians and internists. Alternatively, women may realize that this arrangement is necessary to obtain needed services, particularly screening for cervical and breast cancer, gynecologic care, and contraception. If these practice patterns continue, any limitation on women's access to providers places them at increased risk of not receiving a full complement of care.
      If a dual or multiple provider arrangement of primary care persists, however, there will be little incentive for physician specialty groups to acquire or maintain a broad range of diagnostic, preventive, and therapeutic skills. Simple or arbitrary designation of primary care providers without assurances that training and practices undergo modifications may only increase the magnitude of the problem of fragmentation of care.21 In addition, the identification of multiple primary care specialties as primary care providers will affect workforce and reimbursement policies.
      Much of the available data about practice patterns and use were gathered prior to the expansion of managed care systems. Future studies will help to delineate the influence of managed care on patient preferences and provider practices and determine which arrangements of primary care for women are efficient and result in resource-savings, quality care, and patient satisfaction. Ultimately, as integrated delivery systems expand, considerations of women's preferences and costs will need to be balanced. Future studies will be necessary to examine the effect that managed care has on the practice patterns of these three physician specialty groups, as well as the quality of primary care that women receive.
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        • Institute of Medicine
        Defining primary care: an interim report. National Academy Press, Washington (DC)1994
        • Bartman BA
        • Moy EM
        • Clancy CM
        Characteristics of women's usual source of care; how do internists compare with other primary care physicians?.
        J Gen Intern Med. 1994; 9: 47
      1. A Gallup study of women's attitudes toward the use of ob/gyn for primary care [Conducted for the American Colleges of Obstetricians and Gynecologists. Gallup Organization, Princeton (NJ)1993 Oct
        • Weisman CS
        • Casard SD
        • Plichta SB
        Types of physicians used by women for regular health care: implications for services received.
        J Womens Health. 1995; 4: 407-416
        • Johns L
        Obstetrics-gynecology as primary care; a market dilemma.
        Health Aff. 1994; 2: 195-200
      2. Moore RG State laws requiring insurers to give women direct access to their obstetrician-gynecologist: should you persue a law in your state. Legisletter Special Issue. 13. 1994: 1-6
        • Seltzer V
        ACOG obtains HMO mandate for direct access to obgyns. American College of Obstetricians and Gynecologists—District II NYS.
        Update. 1994; 8: 2
        • Schappert SM
        National Ambulatory Medical Care Survey: 1991 summary. Advance data from vital and health statistics; no 230.
        National Center for Health Statistics, Hyattsville (MD)1993
        • Bartman BA
        • Weiss KB
        Women's primary care in the United States: a study of practice variation among physician specialties.
        J Womens Health. 1993; 2: 261-268
        • Schappert SM
        Office visits to obstetricians and gynecologists: United States, 1989–90.
        in: Advance data from vital and health statistics; no 223. National Center for Health Statistics, Hyattsville (MD)1992
        • Aiken LH
        • Lewis CE
        • Craig J
        • Mendenhall RC
        • Blendon RJ
        • Rogers DE
        The contribution of specialists to the delivery of primary care.
        N Engl J Med. 1979; 300: 1363
        • Bartman BA
        • Weiss KB
        Women's health care in the ambulatory setting.
        Clin Res. 1991; 39: 595A
        • Horton JA
        • Cruess DF
        • Pearse WH
        Primary and preventive care services provided by obstetrician/gynecologists.
        Obstet Gynecol. 1993; 82: 723-726
        • Weinberger M
        • Saunders AF
        • Samsa GP
        • et al.
        Breast cancer screening in older women: practices and barriers reported by primary care physicians.
        J Am Geriatr Soc. 1991; 39: 22-29
        • Teitelbaum MA
        • Weisman CS
        • Klassen AC
        • Celentano D
        Pap testing intervals: specialty differences in physicians' recommendations in relation to women's Pap testing behavior.
        Med Care. 1988; 26: 607-618
        • Lurie N
        • et al.
        Preventive care for women: does the sex of the physician matter?.
        N Engl J Med. 1993; 329: 478-482
        • Rosenblatt RA
        • Hart LG
        • Gamliel S
        • Goldstein B
        • McClendon BJ
        Identifying primary care disciplines by analyzing the diagnostic content of ambulatory care..
        J Am Board Fam Pract. 1995; 8: 34-35
        • Moy E
        • Bartman BA
        Physician specialty and longitudinality of care.
        J Gen Intern Med. 1995; 10: 60
        • Davis K
        • Rowland D
        • Altman D
        • Collins KS
        • Morris C
        Health insurance: the size and shape of the problem.
        Inquiry. 1995; 32: 196-203
        • Yaffe MJ
        Source of primary health care in an urban center.
        Can Med Assoc J. 1984; 131: 1225-1228
        • Clancy CM
        • Massion CT
        American women's health care: a patchwork quilt with gaps.
        JAMA. 1992; 268: 1918-1920