Capitated Payment for Medical Care and the Role of the Physician
Authors: Harry P. Selker
Journal: Annals of Internal Medicine (1996)

Editorials15 February 1996Capitated Payment for Medical Care and the Role of the PhysicianHarry P. Selker, MD, MSPHHarry P. Selker, MD, MSPHNew England Medical Center, Tufts University School of Medicine, Boston, MA 02111Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-124-4-199602150-00010 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail If a patient's employer or health insurer walked into a physician's office while the patient was waiting to be seen and offered the physician money to withhold services from the patient, the physician would probably give a frosty refusal. To do otherwise would be contrary to the physician's role as trusted advocate for the patient's best interests. And yet, this conflict of interest is central to capitated care, which is increasingly accepted by physicians: Employers and health insurers do create financial incentives to withhold care. Efforts to manage this conflict of interest, such as those proposed by Swartz and Brennan ...References1. Swartz K, Brennan TA. Integrated health care, capitated payment, and quality: the role of regulation. Ann Intern Med. 1996; 124:442-8. Google Scholar2. Fuchs VR. No pain, no gain. Perspectives on cost containment. JAMA. 1993; 269:631-3. Google Scholar3. Siu AL, Sonnenberg FA, Manning WG, Goldberg GA, Bloomfield ES, Newhouse JP, et al. Inappropriate use of hospitals in a randomized trial of health insurance plans. N Engl J Med. 1986; 315:1259-66. Google Scholar4. Lurie N, Christianson J, Finch M, Moscovice I. The effects of capitation on health and functional status of the Medicaid elderly. A randomized trial. Ann Intern Med. 1994; 120:506-11. Google Scholar5. Kerr EA, Mittman BS, Hays RD, Siu AL, Leake B, Brook RH. Managed care and capitation in California: how do physicians at financial risk control their own utilization? Ann Intern Med. 1995; 123:500-4. Google Scholar6. Stevens CM. Health care cost containment: some implications of global budgets. Science. 1993; 296:16-7, 105. Google Scholar7. Rodwin MA. Conflicts in managed care. N Engl J Med. 1995; 332:604-7. Google Scholar8. Kassirer JP. Managed care and the morality of the marketplace [Editorial]. N Engl J Med. 1995; 333:50-2. Google Scholar9. Hillman AL. Financial incentives for physicians in HMOs. Is there a conflict of interest? N Engl J Med. 1987; 317:1743-8. Google Scholar10. Gieszl H. Managed care: organizational structures and litigation prospects. In: Ott RA, Tanner TM, Henderson B, eds. Managed Care and the Cardiac Patient. Philadelphia: Hanley & Belfus; 1995:9-30. Google Scholar11. Shapiro MF, Wenger NS. Rethinking utilization review [Editorial]. N Engl J Med. 1995; 333:1353-4. Google Scholar12. Havighurst CC. Health care choices: private contract as instruments of health reform. Washington, DC: American Enterprise Institute Pr; 1995:138-40. Google Scholar Author, Article, and Disclosure InformationAuthors: Harry P. Selker, MD, MSPHAffiliations: New England Medical Center, Tufts University School of Medicine, Boston, MA 02111Corresponding Author: Harry P. Selker, MD, MSPH, Division of Clinical Care Research, New England Medical Center #63, 750 Washington Street, Boston, MA 02111. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoIntegrated Health Care, Capitated Payment, and Quality: The Role of Regulation Katherine Swartz and Troyen A. Brennan Metrics Cited byPatient protection and risk selectionThe future of capitation The physician role in managing change in practiceJust What the Patient Ordered: The Case for Result-Based Compensation ArrangementsJust What the Patient Ordered: The Case for Result-Based Compensation ArrangementsWhen Sick Patients Switch Primary Care PhysiciansEthical Guidelines for Physician Compensation Based on CapitationPayment by Capitation and the Quality of Care 15 February 1996Volume 124, Issue 4Page: 449-451KeywordsConflicts of interestHealth careHealth care utilizationHealth insuranceHealth maintenance organizationsMedical servicesMotivationPatient advocacyPatientsPrimary care physicians ePublished: 15 August 2000 Issue Published: 15 February 1996 Copyright & PermissionsCopyright © 1996 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...