Blue Shield to Cut Some Doctor Payments : Health care: The reduction of up to 4.5% in several health plans follows a similar move by Blue Cross.

Hoping to rein in health care costs, Blue Shield of California said it will cut payments by up to 4.5% to doctors in several of its health plans, affecting about 1 million members throughout the state.

Blue Shield’s announcement follows a similar move earlier this year by Blue Cross of California, which slashed payments to specialist doctors by 5% to 6%. As two of the nation’s largest managed care networks, Blue Cross and Blue Shield are expected to fuel attempts by insurers nationwide to reduce doctor bills.

Blue Shield said its lower fees, effective Jan. 1, involve a switch to a Medicare-like payment system that will affect about 44,000 doctors who contract with the firm’s Preferred Plans, preferred-provider organizations or its Major Benefits Plans, traditional insurance plans.

Blue Shield said the new plan will generally reduce payments for some specialty services, such as surgery or radiology. In some cases, it would provide greater reimbursement for primary care services, such as an initial diagnosis, physical examinations and preventive services.

The moves by Blue Shield and Blue Cross are part of a national trend by health insurers to expand the proportion of care provided by primary care physicians and reduce the use of more-expensive specialists. President Clinton’s health care reform plan also seeks to encourage more use of family physicians.

Dr. Wade M. Aubry, Blue Shield’s medical director, said the new payment system offers “a balanced and reasonable approach” to determining doctors’ fees.

Aubry said the new system will reduce reimbursements to about 50% of doctors serving Blue Shield members. For other physicians in the plans, half will see increased payments and half will see no change, he said.

Blue Shield said it will no longer pay more to obstetricians for births by Cesarean section than is paid for normal vaginal deliveries.

“This should help curb, in some cases, the overuse of this (C-section) procedure,” said Michael G. Odom, a Blue Shield spokesman.

Such cost-cutting moves will only add to doctors’ growing anxiety about what the future of managed care will mean for them. Some specialists in Southern California and elsewhere have already seen patient referrals--and their incomes--fall off sharply.

Danielle Walters, a spokeswoman for the California Medical Assn., said Blue Shield consulted with the physician group before announcing the fee cuts. But she said the CMA has not yet analyzed the impact of the cuts on doctors’ salaries.

“Obviously, we do not like to see fee reductions,” Walters said, “but we are sympathetic that the health care system needs to be constrained, as long as the cuts are shared across the board.”