Joyce Ching her life. Michael Gonzalez, attorney for Gaines, says greed played no part in his client's medical decisions. Gaines did err, say the medical experts Gonzalez consulted, in not picking up on complaints of rectal bleeding. Formerly, when doctors provided care, they made money. Researchers who looked at payment arrangements of 138 managed-care plans in 20 metropolitan areas found a hodgepodge.
Capitation is a key element.
The survey found 56 percent of IPAs used capitation as the chief method of paying doctors, compared with 34 percent of group or staff HMOs and 7 percent of PPOs. Even uncapitated plans find ways to push at least part of the cost of caring for expensive patients onto doctors. In the Chings' plan, for instance, the contract holds the doctor partially responsible for the cost of continued care when the capitated payment is exhausted. A bonus carrot. Other plans dangle a bonus of sorts at cost-conscious doctors.