If funds from the capitation pool are spent on one patient, they will not be available later for that patient or other patients in the plan. Physicians have expertise regarding the benefits and risks of medical interventions and make recommendations to patients. If physicians take no responsibility for restraining costs, the socially important goal of cost containment will fail or will be carried out in ways that fail to take into account individual patient circumstances. Without physician judgment in particular cases, restrictions on care will be meted out by administrators with no clinical expertise. In this view, given the importance of controlling the costs of health care, physicians need to use their clinical judgment to implement cost-containment measures.
Critics object to the role of stewardship for physicians in managed care.
First, prudent patients and physicians have no assurance that any savings in health care expenditures will benefit patients, their families or others in the community. Instead, savings may be dispensed as salaries for executives or dividends to shareholders of for-profit plans. Second, the size of the common resource pool can be increased. Critics contend that restrictions on care would not be required, or would be less stringent, if administrative costs and profits were reduced.