Increasing Number of Doctors Leaving Managed Care, Moving Toward Cash-Only Practices

The Chicago Tribune on May 11 reported on the increasing number of physicians nationwide who have dropped their contracts with managed care plans and are asking their patients to pay for services in cash. Although a 1999 American Medical Association survey found that about 90% of physicians had at least one contract with a managed care or private health plan, the Tribune reports that "shrinking" reimbursements from health insurers and Medicare, increased medical malpractice costs and the "restrictions of managed care" have prompted some doctors to end their participation in the plans. The physicians who decide to leave managed care plans "usually are more established doctors" with insured and uninsured patients who can afford to pay for services in cash. Patients with health insurance can submit claims for reimbursement, the Tribune reports. Some doctors also offer discounted rates for patients who pay cash for services, and some physician networks charge an annual membership fee for discounted rates. "I think that this is a trend that ... is probably just starting," Paul Ginsburg, president of the Center for Studying Health System Change, said, adding, "But it has the potential to affect a lot more doctors and patients ... and to stimulate a response from health plans" (Anderson, Chicago Tribune, 5/12).