{"id":"https://openalex.org/W1981069169","doi":"https://doi.org/10.1001/archinte.158.15.1626","title":"Effects of managed care on physician-patient relationships, quality of care, and the ethical practice of medicine: a physician survey.","display_name":"Effects of managed care on physician-patient relationships, quality of care, and the ethical practice of medicine: a physician survey.","publication_year":1998,"publication_date":"1998-08-10","ids":{"openalex":"https://openalex.org/W1981069169","doi":"https://doi.org/10.1001/archinte.158.15.1626","mag":"1981069169","pmid":"https://pubmed.ncbi.nlm.nih.gov/9701096"},"language":"en","primary_location":{"id":"pmid:9701096","doi":"https://doi.org/10.1001/archinte.158.15.1626","is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/9701096","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Archives of internal medicine","raw_type":"Journal Article"},"volume":null,"type":"article","indexed_in":["pubmed"],"open_access":{"is_oa":false,"oa_status":"closed","oa_url":null,"any_repository_has_fulltext":false},"authorships":[{"author_position":"first","author":{"id":"https://openalex.org/A5063385272","display_name":"Debra S. Feldman","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"D S Feldman","raw_affiliation_strings":["MCP Hahnemann School of Medicine, Allegheny University of the Health Sciences, Philadelphia, PA, USA"],"raw_orcid":null,"affiliations":[{"raw_affiliation_string":"MCP Hahnemann School of Medicine, Allegheny University of the Health Sciences, Philadelphia, PA, USA","institution_ids":[]}]},{"author_position":"middle","author":{"id":"https://openalex.org/A5034451271","display_name":"Dennis H. Novack","orcid":null,"observed_orcids":[]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"D H Novack","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]},{"author_position":"last","author":{"id":"https://openalex.org/A5049918533","display_name":"Edward J. Gracely","orcid":"https://orcid.org/0000-0002-8344-3223","observed_orcids":["https://orcid.org/0000-0002-8344-3223"]},"institutions":[],"countries":[],"is_corresponding":false,"raw_author_name":"E Gracely","raw_affiliation_strings":[],"raw_orcid":null,"affiliations":[]}],"institutions":[],"countries_distinct_count":0,"institutions_distinct_count":0,"corresponding_author_ids":[],"corresponding_institution_ids":[],"apc_list":null,"apc_paid":null,"fwci":28.7949,"has_fulltext":false,"cited_by_count":135,"citation_normalized_percentile":{"value":0.99488432,"is_in_top_1_percent":true,"is_in_top_10_percent":true},"cited_by_percentile_year":{"min":88,"max":99},"biblio":{"volume":"158","issue":"15","first_page":"1626","last_page":"32"},"is_retracted":false,"is_paratext":false,"is_xpac":false,"primary_topic":{"id":"https://openalex.org/T10391","display_name":"Healthcare Policy and Management","score":0.6083999872207642,"subfield":{"id":"https://openalex.org/subfields/2002","display_name":"Economics and Econometrics"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},"topics":[{"id":"https://openalex.org/T10391","display_name":"Healthcare Policy and Management","score":0.6083999872207642,"subfield":{"id":"https://openalex.org/subfields/2002","display_name":"Economics and Econometrics"},"field":{"id":"https://openalex.org/fields/20","display_name":"Economics, Econometrics and Finance"},"domain":{"id":"https://openalex.org/domains/2","display_name":"Social Sciences"}},{"id":"https://openalex.org/T11590","display_name":"Primary Care and Health Outcomes","score":0.358599990606308,"subfield":{"id":"https://openalex.org/subfields/3600","display_name":"General Health Professions"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}},{"id":"https://openalex.org/T11537","display_name":"Ethics in medical practice","score":0.010300000198185444,"subfield":{"id":"https://openalex.org/subfields/3600","display_name":"General Health Professions"},"field":{"id":"https://openalex.org/fields/36","display_name":"Health Professions"},"domain":{"id":"https://openalex.org/domains/4","display_name":"Health Sciences"}}],"keywords":[{"id":"https://openalex.org/keywords/managed-care","display_name":"managed care","score":1.0},{"id":"https://openalex.org/keywords/physician-patient-relationship","display_name":"physician-patient relationship","score":0.9610000252723694},{"id":"https://openalex.org/keywords/quality-of-care","display_name":"quality of care","score":0.8640000224113464},{"id":"https://openalex.org/keywords/medical-ethics","display_name":"medical ethics","score":0.9670000076293945},{"id":"https://openalex.org/keywords/primary-care-physicians","display_name":"primary care physicians","score":0.7229999899864197},{"id":"https://openalex.org/keywords/conflict-of-interest","display_name":"conflicts of interest","score":0.9240000247955322},{"id":"https://openalex.org/keywords/patient-autonomy","display_name":"patient autonomy","score":0.9800000190734863},{"id":"https://openalex.org/keywords/confidentiality","display_name":"confidentiality","score":0.8309999704360962},{"id":"https://openalex.org/keywords/informed-consent","display_name":"informed consent","score":0.9990000128746033},{"id":"https://openalex.org/keywords/health-care-reform","display_name":"health care reform","score":0.9079999923706055}],"concepts":[{"id":"https://openalex.org/C71745522","wikidata":"https://www.wikidata.org/wiki/Q2476929","display_name":"Confidentiality","level":2,"score":0.6757432818412781},{"id":"https://openalex.org/C2780265253","wikidata":"https://www.wikidata.org/wiki/Q1416012","display_name":"Managed care","level":3,"score":0.6756764054298401},{"id":"https://openalex.org/C65414064","wikidata":"https://www.wikidata.org/wiki/Q484105","display_name":"Autonomy","level":2,"score":0.63770991563797},{"id":"https://openalex.org/C512399662","wikidata":"https://www.wikidata.org/wiki/Q3505712","display_name":"Family medicine","level":1,"score":0.6240698099136353},{"id":"https://openalex.org/C105776082","wikidata":"https://www.wikidata.org/wiki/Q617473","display_name":"Likert scale","level":2,"score":0.5790810585021973},{"id":"https://openalex.org/C71924100","wikidata":"https://www.wikidata.org/wiki/Q11190","display_name":"Medicine","level":0,"score":0.5676721334457397},{"id":"https://openalex.org/C160735492","wikidata":"https://www.wikidata.org/wiki/Q31207","display_name":"Health care","level":2,"score":0.5054926872253418},{"id":"https://openalex.org/C2779530757","wikidata":"https://www.wikidata.org/wiki/Q1207505","display_name":"Quality (philosophy)","level":2,"score":0.4546400308609009},{"id":"https://openalex.org/C159110408","wikidata":"https://www.wikidata.org/wiki/Q121176","display_name":"Nursing","level":1,"score":0.4436178505420685},{"id":"https://openalex.org/C15744967","wikidata":"https://www.wikidata.org/wiki/Q9418","display_name":"Psychology","level":0,"score":0.28791874647140503},{"id":"https://openalex.org/C111472728","wikidata":"https://www.wikidata.org/wiki/Q9471","display_name":"Epistemology","level":1,"score":0.0},{"id":"https://openalex.org/C17744445","wikidata":"https://www.wikidata.org/wiki/Q36442","display_name":"Political science","level":0,"score":0.0},{"id":"https://openalex.org/C50522688","wikidata":"https://www.wikidata.org/wiki/Q189833","display_name":"Economic growth","level":1,"score":0.0},{"id":"https://openalex.org/C162324750","wikidata":"https://www.wikidata.org/wiki/Q8134","display_name":"Economics","level":0,"score":0.0},{"id":"https://openalex.org/C138885662","wikidata":"https://www.wikidata.org/wiki/Q5891","display_name":"Philosophy","level":0,"score":0.0},{"id":"https://openalex.org/C199539241","wikidata":"https://www.wikidata.org/wiki/Q7748","display_name":"Law","level":1,"score":0.0},{"id":"https://openalex.org/C138496976","wikidata":"https://www.wikidata.org/wiki/Q175002","display_name":"Developmental psychology","level":1,"score":0.0}],"mesh":[{"descriptor_ui":"D001291","descriptor_name":"Attitude of Health Personnel","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D004992","descriptor_name":"Ethics, Medical","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D005260","descriptor_name":"Female","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D006801","descriptor_name":"Humans","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D008297","descriptor_name":"Male","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D008329","descriptor_name":"Managed Care Programs","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D008875","descriptor_name":"Middle Aged","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D010414","descriptor_name":"Pennsylvania","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D010817","descriptor_name":"Physician-Patient Relations","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D010821","descriptor_name":"Physicians, Family","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D010822","descriptor_name":"Physicians, Women","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D011787","descriptor_name":"Quality of Health Care","qualifier_ui":null,"qualifier_name":null,"is_major_topic":true},{"descriptor_ui":"D030881","descriptor_name":"Disclosure","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false},{"descriptor_ui":"D035502","descriptor_name":"Trust","qualifier_ui":null,"qualifier_name":null,"is_major_topic":false}],"locations_count":1,"locations":[{"id":"pmid:9701096","doi":"https://doi.org/10.1001/archinte.158.15.1626","is_oa":false,"landing_page_url":"https://pubmed.ncbi.nlm.nih.gov/9701096","pdf_url":null,"source":{"id":"https://openalex.org/S4306525036","display_name":"PubMed","issn_l":null,"issn":null,"is_oa":false,"is_in_doaj":false,"is_core":false,"listed_in":[],"host_organization":"https://openalex.org/I1299303238","host_organization_name":"National Institutes of Health","host_organization_lineage":["https://openalex.org/I1299303238"],"host_organization_lineage_names":[],"type":"repository"},"license":null,"license_id":null,"version":"publishedVersion","is_accepted":true,"is_published":true,"raw_source_name":"Archives of internal medicine","raw_type":"Journal Article"}],"best_oa_location":null,"sustainable_development_goals":[{"score":0.9391000270843506,"id":"https://metadata.un.org/sdg/3","display_name":"Good health and well-being"}],"sustainable_development_goals_aurora":[{"score":0.5099999904632568,"id":"https://metadata.un.org/sdg/5","display_name":"Gender equality"}],"study_designs":[{"id":"https://openalex.org/study-designs/observational-study","display_name":"Observational Study"}],"awards":[],"funders":[],"has_content":{"grobid_xml":false,"pdf":false},"content_urls":null,"referenced_works_count":49,"referenced_works":["https://openalex.org/W624874713","https://openalex.org/W1965417958","https://openalex.org/W1966094122","https://openalex.org/W1967004194","https://openalex.org/W1975147264","https://openalex.org/W1976436627","https://openalex.org/W1977734707","https://openalex.org/W1979985564","https://openalex.org/W1980427095","https://openalex.org/W1982407739","https://openalex.org/W1985730730","https://openalex.org/W1988567978","https://openalex.org/W2002515644","https://openalex.org/W2002973854","https://openalex.org/W2003318187","https://openalex.org/W2006131277","https://openalex.org/W2014408125","https://openalex.org/W2025431661","https://openalex.org/W2028280448","https://openalex.org/W2039016345","https://openalex.org/W2046404147","https://openalex.org/W2055739294","https://openalex.org/W2057477706","https://openalex.org/W2063983226","https://openalex.org/W2071965482","https://openalex.org/W2078700554","https://openalex.org/W2084024733","https://openalex.org/W2085136026","https://openalex.org/W2088020509","https://openalex.org/W2091594945","https://openalex.org/W2121827944","https://openalex.org/W2124287638","https://openalex.org/W2161147921","https://openalex.org/W2168095220","https://openalex.org/W2315412491","https://openalex.org/W2327224720","https://openalex.org/W2408809911","https://openalex.org/W2411856453","https://openalex.org/W2412446665","https://openalex.org/W2412933415","https://openalex.org/W2440160692","https://openalex.org/W2468277578","https://openalex.org/W2608086139","https://openalex.org/W2609886196","https://openalex.org/W3005687972","https://openalex.org/W4229659360","https://openalex.org/W4237793003","https://openalex.org/W4250039107","https://openalex.org/W4285719527"],"related_works":["https://openalex.org/W1528833026","https://openalex.org/W2223377803","https://openalex.org/W2404656024","https://openalex.org/W2395631831","https://openalex.org/W2147287190","https://openalex.org/W2591406852","https://openalex.org/W1977618234","https://openalex.org/W2011394001","https://openalex.org/W2104781451","https://openalex.org/W2400797290"],"abstract_inverted_index":{"BACKGROUND:":[0],"Survey":[1],"studies":[2],"have":[3,247],"shown":[4],"that":[5,106,133,185],"physicians":[6,23,40,61,110,183,211,219],"believe":[7,221],"managed":[8,30,108,186,215,222],"care":[9,22,31,60,109,137,187,223,251],"is":[10,138],"having":[11],"significant":[12,156,206,225],"impact":[13,28,190],"on":[14,70,191,228,240],"many":[15],"of":[16,29,39,51,117,127,135,144,148,153,242],"their":[17,44],"professional":[18,45],"obligations.":[19],"METHODS:":[20],"Primary":[21],"were":[24,68,202],"asked":[25],"about":[26],"the":[27,37,95,124,163,229,232],"on:":[32],"(1)":[33],"physician-patient":[34,180,230],"relationships,":[35],"(2)":[36],"ability":[38,165,192,233],"to":[41,79,93,114,122,166,171,176,193,198,234],"carry":[42,167,235],"out":[43,168,236],"ethical":[46,169,237],"obligations,":[47,170,238],"and":[48,119,151,175,239],"(3)":[49],"quality":[50,134,241],"patient":[52,173,243],"care.":[53,216,244],"In":[54],"1996":[55],"we":[56],"surveyed":[57,220],"1011":[58],"primary":[59],"in":[62,142,162,179],"Pennsylvania.":[63],"The":[64,83,98,130],"survey":[65],"group's":[66],"responses":[67],"graded":[69],"a":[71,160],"Likert":[72],"scale.":[73],"Space":[74],"was":[75,91,101],"provided":[76],"for":[77,249],"respondents":[78,104],"include":[80],"written":[81],"comments.":[82],"SPSS":[84],"statistical":[85],"software":[86],"(SPSS":[87],"Inc,":[88],"Chicago,":[89],"Ill)":[90],"used":[92],"analyze":[94],"data.":[96],"RESULTS:":[97],"response":[99],"rate":[100],"55%.":[102],"Most":[103,182],"indicated":[105],"under":[107],"are":[111],"less":[112,120],"able":[113,121],"avoid":[115],"conflicts":[116],"interest":[118],"place":[123],"best":[125],"interests":[126],"patients":[128],"first.":[129],"majority":[131],"responded":[132],"health":[136,250],"compromised":[139],"by":[140],"limitations":[141],"location":[143],"diagnostic":[145],"tests,":[146],"length":[147],"hospital":[149],"stay,":[150],"choice":[152],"specialists.":[154],"A":[155],"minority":[157],"(27%-49%)":[158],"noted":[159],"decrease":[161],"physician's":[164],"respect":[172,177],"autonomy,":[174],"confidentiality":[178],"communication.":[181],"expressed":[184],"made":[188],"no":[189],"obtain":[194],"informed":[195],"consent":[196],"or":[197],"provide":[199],"information.":[200],"There":[201],"small":[203],"but":[204],"statistically":[205],"sex":[207],"differences,":[208],"with":[209],"female":[210],"more":[212],"negative":[213,226],"toward":[214],"CONCLUSIONS:":[217],"Many":[218],"has":[224],"effects":[227],"relationship,":[231],"These":[245],"results":[246],"implications":[248],"system":[252],"reform":[253],"efforts.":[254]},"counts_by_year":[{"year":2024,"cited_by_count":2},{"year":2022,"cited_by_count":2},{"year":2021,"cited_by_count":1},{"year":2020,"cited_by_count":4},{"year":2019,"cited_by_count":3},{"year":2018,"cited_by_count":1},{"year":2017,"cited_by_count":3},{"year":2016,"cited_by_count":2},{"year":2015,"cited_by_count":2},{"year":2014,"cited_by_count":3},{"year":2013,"cited_by_count":2},{"year":2012,"cited_by_count":7}],"updated_date":"2026-10-31T12:09:11.096373","created_date":"2016-06-24T00:00:00"}