March 24, 1999
Web posted at: 1:56 p.m. EST (1856 GMT)

WASHINGTON (CNN) -- Managed care means less charity care as market pressure dissuades doctors from offering their services to patients in financial need, a leading medical journal reported this week.

The study, by The Center for Studying Health System Change, found physicians who are heavily involved with managed care plans tend to provide less charity care, the Journal of the American Medical Association (JAMA) reported. The center is a project of the non-profit Robert Wood Johnson Foundation.

The researchers found that doctors who got more money from managed care provided less charity care than colleagues who didn't receive as much of their income from a managed care organization.

Charity care was defined as free care or care provided at a reduced cost because of a patient's financial need.

"Many physicians are experiencing increased financial pressures, greater competition for paying patients and less ability to shift the costs of uncompensated care onto other payers," the authors wrote. Doctors could reduce or eliminate charity care as a result, they said.

The value of charity care was "estimated as high as $11 billion in 1994," according to the study's authors.

Researchers studied the results of a 1996-1997 national survey which asked 10,881 doctors from 60 communities the number of charity care hours they provided in the month prior to being interviewed.

According to their findings, most physicians -- more than 77 percent -- provided an average of 10.3 hours of charity care a week.

But doctors who relied on managed care for 85 percent of their income typically volunteered only five hours a month. Doctors in larger group practices often have less discretion to provide charity care, and organizational and structural barriers "intentionally or unintentionally" discourage it, the survey concluded.

The results also suggested that doctors in cities where managed care makes up a large part of the medical community provide less charity care.

Doctors who work outside the managed care system "still have the independence to be doctor, and to be able to say 'look, just come in and I'll take care of that,' " said Dr. Gloria Wilderbrathwaite, a Washington, D.C. physician who volunteers 32 hours of her time a month.

The managed care industry says cost cutting has had an impact on the ability to provide free care for those who need it. But they argue that employers' desire for cheaper insurance is to blame. Industry officials are also critical of cuts in public hospital budgets at both the state and federal level.

"We need to go back to the issue of where the additional resources are going to come from in our society to deal with the folks who fall in the gaps," said Karen Ignagni, a spokeswoman for the American Association of Health Plans.

Medical Correspondent Eileen O'Connor contributed to this report.