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Editorials |1 October 1995

Physicians in Control of the Capitated Dollar: Do unto Others …

Stanley Goldfarb, MD

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Copyright ©2004 by the American College of Physicians
2004
  • From Graduate Health System Philadelphia, PA 19103. Requests for Reprints: Stanley Goldfarb, MD, Graduate Health System, 2129 Chestnut Street, Philadelphia, PA 19103.
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The medical profession and its leadership have loudly questioned the effect that marketplace-driven changes are having and will have on the practice of medicine and the physician–patient relationship [1]. For-profit health care delivery organizations are seen as having an unavoidable conflict between the interests of patients and those of shareholders [2, 3]. Some believe that physician-led organizations delivering health care would avoid the stockholder-satisfying mentality of many for-profit insurance companies and, therefore, that physician-directed enterprises would direct more resources toward patient care and fewer into providing a return on stockholders' investments [4]. However, these conclusions depend on the assumption that physicians will act differently than managed care companies when faced with the economic imperative of a fully prepaid system in which they are at full financial risk. Implicit in previous criticisms of the efforts of insurance companies to manage medical care is the concern that medical management really means denial of needed services.
It is widely believed that if physicians could control the system and use clinical judgment to steer patients through the maze of diagnostic and therapeutic choices of modern medicine, profits might be lower but patient interests would be enhanced. Physician-led health maintenance organizations have been proposed in several locations as a way to apply this belief.
In this issue, Kerr and colleagues [5] raise important concerns about these assumptions. When faced with the daunting dual tasks of caring for patients' physical well-being and bearing the financial risk of their care, physician-owned groups seem to...
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Goldfarb S. Physicians in Control of the Capitated Dollar: Do unto Others …. Ann Intern Med. 1995;123:546–547. doi: 10.7326/0003-4819-123-7-199510010-00010

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Published: Ann Intern Med. 1995;123(7):546-547.

DOI: 10.7326/0003-4819-123-7-199510010-00010

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