The methods used to compensate managed care providers may encourage them to provide less, rather than more, care to plan participants. Public disclosure of financial arrangements with doctors, as well as information on utilization review standards and decisions, grievance or appeals procedures, and limitations of coverage, are extremely important. Consumer oversight boards, including health care workers and union representatives, can be a vital part of protecting patients' rights. Currently, about 60 percent of managed care plans pay physicians on a capitation basis. Some pay a bonus to those who keep costs below a certain level, or apply penalties to those who exceed specified costs.
Many plans restrict physicians from disclosing incentives to limit patient care.
Try to find out how physicians are paid. Look at statistics on the number of complaints and how they were resolved, including average time for resolutions. Consider whether the plan provides for review by an impartial outside arbitrator with medical training and whether the arbitrator's decision is advisory or binding.