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The Effects of Organizational Structure on Primary Care Outcomes under Managed Care

Donald A. Barr, MD, PhD
[+] Article, Author, and Disclosure Information

From Stanford Center for Organizations Research, Stanford University, Stanford, California. Requests for Reprints: Donald A. Barr, MD, PhD, 1249 Cedar Street, Palo Alto, CA 94301. Acknowledgments: The author thanks Dr. Peter Rudd for his review of and comments on this manuscript.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1995;122(5):353-359. doi:10.7326/0003-4819-122-5-199503010-00006
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The advent of managed care in the United States brings with it more and larger organizations involved in providing primary care.Studies of organizations in general suggest that large managed care organizations will have difficulty providing high-quality primary care largely because of their complexity and the fragmentation of their work force. Existing data confirm that these organizations have shortcomings in both patient and physician satisfaction. There are few data to indicate whether such organizations can mitigate these problems by saving costs through economies of scale. To offset their inherent weaknesses, large primary care organizations need to ensure patients' accessibility to their physicians, the continuity of the physician–patient relationship, a care environment conducive to a high-quality physician–patient interaction, and the clinical autonomy of physicians. Much additional research needs to be done to further understand these issues.


Grahic Jump Location
Figure 1.
The relation between organizational size, the cost of care, and patient satisfaction.

As organizations get larger, patient satisfaction decreases and costs initially decrease, level out, and then begin to increase.

Grahic Jump Location




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