Health Maintenance Organizations, Financial Incentives, and Physicians' Judgments
Authors: Alan L. Hillman
Journal: Annals of Internal Medicine (1990)

Editorials15 June 1990Health Maintenance Organizations, Financial Incentives, and Physicians' JudgmentsAlan L. Hillman, MD, MBAAlan L. Hillman, MD, MBASearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-112-12-891 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptHealth maintenance organizations (HMOs) use financial incentives to influence physicians' clinical decisions (1). Although many physicians claim that they are somehow immune to these measures, research proves otherwise (2) and common sense dictates that HMOs would not continue to use financial incentives if they did not perceive that they work. Physicians (and patients) respond to what is in their pecuniary interests (3-8). The crucial question is not whether financial incentivesaffectphysicians' decisions, but whether some financial incentivesdistortphysicians' judgment. In other words, in the pursuit of cost-effective medicine, do some HMO incentives influence doctors to conserve medical resources...References1. Hillman A. Financial incentives for physicians in HMOs. Is there a conflict of interest? N Engl J Med. 1987;317:1743-8. CrossrefMedlineGoogle Scholar2. HillmanPaulyKerstein AMJ. How do financial incentives affect physicians' clinical decisions and the financial performance of health maintenance organizations? N Engl J Med. 1989;321:86-92. CrossrefMedlineGoogle Scholar3. EgdahlTaft RC. Financial incentives to physicians. N Engl J Med. 1986;315:59-61. CrossrefMedlineGoogle Scholar4. Enthoven A. Shattuck Lecture—cutting cost without cutting the quality of care. N Engl J Med. 1978;298:1229-38. CrossrefMedlineGoogle Scholar5. Ramsdell J. Physician reimbursement for services to HMO-sponsored patients. An academic model. Med Care. 1985;23:1315-21. CrossrefMedlineGoogle Scholar6. ShapiroWareSherbourne MJC. Effects of cost sharing on seeking care for serious and minor symptoms. Results of randomized controlled trial. Ann intern Med. 1986;104:246-51. LinkGoogle Scholar7. HeldReinhardt PU. Analysis of Economic Performance in Medical Group Practice. Princeton, New Jersey: Mathematica Policy Research Institute; 1979.(Report #79-05). Google Scholar8. MeierTillotson GJ. Physician Reimbursement and Hospital Use in HMOs. Excelsior, Minnesota: InterStudy; 1978. Google Scholar9. Annual Report to Congress 1989. Washington, DC: Physician Payment Review Commission; 1989. Google Scholar10. . Medicare: Physician Incentive Payments by Prepaid Health Plans Could Lower Quality of Care. GAO/HRD-89-29, Washington, DC; 1988. Google Scholar11. Hillman A. The technologic imperative. In: Nash DB, ed. Future Practice Alternatives in Medicine. New York: Igaku-Shoin; 1987. Google Scholar12. Levinson D. Toward full disclosure of referral restrictions and financial incentives by prepaid health plans. N Engl J Med. 1987;317:1729-31. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. 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Arnold, MD, Lachlan Forrow, MDFinancial IncentivesStephen E. Silver, MD 15 June 1990Volume 112, Issue 12Page: 891-893KeywordsHealth maintenance organizationsHospital medicineMotivation Issue Published: 15 June 1990 PDF downloadLoading ...