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January 21, 1998

Physicians' Ratings of Health Plans

Author Affiliations

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

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

To the Editor.—While sympathetic to the idea of physicians evaluating health plans, we note that the findings of Dr Borowsky and colleagues1 highlight some of the difficulties that are yet to be overcome if such ratings are to be helpful to consumers and purchasers. If the purpose of comparative physician ratings is to assist consumers in understanding differences between managed care health plans, such "report cards" must account for a wide variety of potential bias. These confounding variables include not only physician differences, but also differences in patients, in medical groups, and in the characteristics of the local community. Each of these might influence either physician attitudes toward, or actual physician experience with, health plans. An especially problematic confounder arises when physicians have a strong relationship with the health plan as a partner or an employee.