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Independent practice association physician groups in California.

We surveyed independent practice association (IPA) physician groups in California about their approaches to staffing, physician payment, and governance. Most IPAs desired more primary care physicians but not more specialists. Capitation was the major mode of remuneration for primary care physicians in 77 percent of IPAs, and for specialists in 30 percent of IPAs. Most IPAs also used financial incentives related to use of referral or ancillary services. Boards of directors were dominated by physicians, but governance tended to be centralized rather than highly democratic. We found that IPAs mirror many of the broader trends in physician staffing and physician payment that exist in managed care organizations.

California↗

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Medicaid managed care's impact on safety-net clinics in California.

A growing percentage of Medicaid patients are receiving medical care within a managed care system. This policy change has raised concerns about whether safety-net providers can maintain their share of Medi-Cal (California Medicaid) patients. From 1995 to 1997 several of California's counties implemented mandatory Medi-Cal managed care. The majority of California's safety-net primary care clinics experienced a decline in the percentage of their patients insured by Medi-Cal. However, after the overall decline in the number of Medi-Cal beneficiaries was controlled for, the increased penetration of Medi-Cal managed care in a county was not independently associated with a decline in clinics' share of Medi-Cal patients. Despite this fact, it may become increasingly difficult for clinics to maintain their current level of services with declining Medi-Cal enrollment and other anticipated reforms in their funding.

Ambulatory Care Facilities↗