LETTER
Physician Disclosure of Financial Incentives
Jon Yardney, MD
1 July 1993 | Volume 119 Issue 1 | Page 95
TO THE EDITOR:
Given the rapid growth of for-profit health maintenance organizations (HMOs) that use physicians in private practice as gatekeepers, I was surprised that the Ethics Committee omitted any specific discussion of ethical issues involving managed care in the third edition of the American College of Physicians Ethics Manual [1]. I offer the following for the Committee's consideration.
Because it is unethical for physicians to receive kickbacks for referring patients to specialists, it must be equally unethical for physician-gatekeepers to accept hidden payments (in the form of risk-sharing bonuses) from an HMO for not referring a patient to a subspecialist or for not ordering expensive tests. Unfortunately, when the patient first enrolls in an HMO, he or she is usually unaware of the existence of such financial disincentives.
Although the HMO is primarily responsible for disclosing its financial disincentives to medical care, physicians also have a duty to disclose to each individual patient any potential conflict of interest, especially if they are recommending an unaggressive and less costly course of evaluation or treatment.
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Author and Article Information
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407 East Lancaster Avenue; St. Davids, PA 19087-4202
1. American College of Physicians Ethics Committee. American College of Physicians Ethics Manual. Third edition. Ann Intern Med. 1992; 117:947-60.
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