Physician Performance: Report Cards Under Development but Challenges Remain Page: 7 of 38
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extent that physician assumption of financial risk affects quality of care,
this trend further shifts the focus on quality from plans to physicians.
For most employed Americans, their employer determines the number and
type o f health insurance plans available to them. For workers whose
employers do not offer a choice of plans, report cards that compare plans
have no utility. A 1997 survey conducted by the Research Triangle Institute
found that less than one in five-17 percent-of private employers that
offered insurance to their employees provided a choice among plans.4
Another study reported that of employers that offer health insurance, 92
percent o f small firms and 44 percent o f larger firms (those with more than
200 employees) offered only one plan in 1998.5 Counting employees rather
than employers, less than half-only 41 percent-of employees who are
offered health insurance can choose from two or more health plans.6
Health plan report cards may also be of little use to more than 14 million
o f the country's 40 million Medic are beneficiaries-those who did no t have
a choice of managed care plans in 1998.7
Report Cards Is
Measures Is Difficult
The heterogeneity of health care makes performance measurement
challenging in terms of identifying measures that truly reflect the quality of
care that individuals receive. Making valid comparisons across plans or
providers that ultimately account for patient differences that affect
outcomes is also difficult. These challenges are magnified in attempts to
measure the performance of physician groups and individual physicians.
For example, unlike plans that have a large number of enrollees, individual
groups or physicians generally see a small number of patients with specific
conditions. These attempts are further complicated by a concern that
consumers and physicians have regarding the use of performance
measurement data in the first place.
Medicine involves a wide variety of services, only a portion of which can
be clearly linked to health outcomes. Health outcomes are also influenced
4The Robert Wood Johnson Foundation, 1997 Employer Health Insurance Survey (Princeton, N.J.:
5Henry J. Kaiser Family Foundation, Health Benefits of Small Employers in 1998 (Menlo Park, Calif.:
Feb. 1999), p. 18.
6Robert Wood Johnson Foundation.
7In 1998, 4 million Medicare beneficiaries had only one managed care plan available in their county and
10.6 million beneficiaries lived in counties with no plan at all. See Medicare Managed Care Plans: Many
Factors Contribute to Recent Withdrawals; Plan Interest Continues (GAO/HEHS-99-91, Apr. 27, 1999).
GAO/HEHS-99-178 Physician Report Cards
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United States. General Accounting Office. Physician Performance: Report Cards Under Development but Challenges Remain, report, September 30, 1999; Washington D.C.. (https://digital.library.unt.edu/ark:/67531/metadc293055/m1/7/: accessed April 21, 2019), University of North Texas Libraries, Digital Library, https://digital.library.unt.edu; crediting UNT Libraries Government Documents Department.