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January 21, 1998

Physicians' Ratings of Health Plans—Reply

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;279(3):193-194. doi:10.1001/jama.279.3.193

In Reply.—Drs Allen and Foldes and Drs Rich and Kralewski reiterate a point we previously made: that physician ratings of health plans could be confounded by various factors. They cite plan type, whether physicians are employed by a plan, and underlying attitudes toward managed care as particularly problematic. We agree that if such confounding occurs it should be addressed. However, because this pilot study was limited to 3 plans in the Twin Cities metropolitan area (where there is only 1 staff model HMO), it was not possible, as Allen and Foldes recognize, to control for plan type. There are no well-established methods to control for physicians' attitudes toward managed care. We currently are launching a national multisite study that will enable us to determine whether such confounding exists and to control for it.

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