FACP Under managed care, physicians face increasingly difficult ethical dilemmas regarding patient care. This strategy is not always in the best interest of the patient. Capitation, for example, encourages physicians to reduce hospitalization rates and use of specialists.
Physicians can easily profit under capitation if they change their practice habits.
We anticipate that as a result of managed care, rare diseases will become even rarer, to the point that their diagnosis will virtually disappear. One of the many challenges facing the internist is the diagnosis of disorders that may require a great deal of physician time, testing, consultations and further investigations. Rare diseases fit into this category because they are costly to diagnose and require very specialized treatments. He had been seen by several primary care physicians, but none spent the necessary time to consider the rare causes of hypertension. He was compliant with medications, but still his blood pressure remained elevated.