As managed care becomes more prominent in rural areas, contractual relationships between physicians and managed care organizations are becoming more complex. Many physician practices are now associated with organizations such as hospitals, physician-hospital organizations, and independent practice associations which act as intermediaries between managed care organizations and the physician practices. This study examines whether the type of contractual arrangement (direct or through an intermediary entity) has an effect on the extent to which rural physician practices assume risk. A survey of rural physician practices in nine states was conducted to analyze this question.
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