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Capitated Payment for Medical Care and the Role of the Physician

Harry P. Selker, MD, MSPH
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New England Medical Center, Tufts University School of Medicine, Boston, MA 02111 Requests for Reprints: Harry P. Selker, MD, MSPH, Division of Clinical Care Research, New England Medical Center #63, 750 Washington Street, Boston, MA 02111.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1996;124(4):449-451. doi:10.7326/0003-4819-124-4-199602150-00010
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If a patient's employer or health insurer walked into a physician's office while the patient was waiting to be seen and offered the physician money to withhold services from the patient, the physician would probably give a frosty refusal. To do otherwise would be contrary to the physician's role as trusted advocate for the patient's best interests. And yet, this conflict of interest is central to capitated care, which is increasingly accepted by physicians: Employers and health insurers do create financial incentives to withhold care. Efforts to manage this conflict of interest, such as those proposed by Swartz and Brennan in this issue [1], are nothing less than attempts to define the role of the physician in the face of such incentives, and they deserve our careful consideration.

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