Mackenzie, Elizabeth

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  • Publication
    Cultural Competence: Essential Measurements of Quality for Managed Care Organizations
    (1996-05-01) Mackenzie, Elizabeth; Lavizzo-Mourey, Risa
    We are currently witnessing a radical change in the health care system in the United States as a result of the managed care juggernaut. Driven by the imperative to stem increasing health care costs, managed care seeks to save money by “managing” health care utilization and narrowing the choices available to health care consumers. Although both cost-saving strategies are effective, they also present a potential threat to quality of care. As HEDIS and other measures of quality are revised, physicians must establish guidelines for quality of care that support the burgeoning managed health care environment. In developing these guidelines and measures, two important trends must be acknowledged and addressed. First, managed care was formerly confined mostly to middle class populations but now envelops many more diverse and vulnerable groups, including Medicaid, Medicare, and minority populations [1]. Second, providing care within a managed care environment requires attention to the population of “covered lives” in addition to individual patients.
  • Publication
    Experiences of Minority Primary Care Physicians With Managed Care: A National Survey
    (1998-10-01) Mackenzie, Elizabeth; Taylor, Lynne S; Lavizzo-Mourey, Risa
    OBJECTIVES: To determine if ethnic minority physicians experience more barriers in acquiring and maintaining managed care contracts than white physicians, and to determine if the physician's perceptions of his or her ability to provide appropriate care to patients varies with physician ethnicity. STUDY DESIGN: Using a national sample, we identified 4 research areas germane to this topic and analyzed them by physician ethnic group. METHODS: Analysis involved a pre-existing data set from a national survey that employed a random sampling approach to achieve reasonably accurate national population estimates with acceptable margins of error (95% CI = +/- 2). RESULTS: A total of 1032 primary care physicians completed the survey (response rate of 48%). After controlling for confounding variables, we found that Asian physicians have the most difficulty keeping managed care contracts. Type of practice varies with physician ethnicity, and solo practitioners have more problems securing contracts than physicians in other types of practices. Board-certified physicians are more likely to have managed care contracts than those who are not. Latino physicians have significantly fewer managed care patients than primary care physicians who are white, African American, or Asian. The perceptions of the physicians of their ability to deliver appropriate care overall did not vary by ethnicity, but 2 major subcategories of this item did vary by physician ethnicity: quality of care, and limitations to providing care. CONCLUSIONS: Although we did not find overwhelming evidence of discrimination against ethnic minority physicians, differences in rates of termination, type of practice, board certification rates, and managed care affiliation were related to physician ethnicity.