Physicians in Control of the Capitated Dollar: Do unto Others …

The medical profession and its leadership have loudly questioned the effect that marketplace-driven changes are having and will have on the practice of medicine and the physician–patient relationship [1]. For-profit health care delivery organizations are seen as having an unavoidable conflict between the interests of patients and those of shareholders [2, 3]. Some believe that physician-led organizations delivering health care would avoid the stockholder-satisfying mentality of many for-profit insurance companies and, therefore, that physician-directed enterprises would direct more resources toward patient care and fewer into providing a return on stockholders' investments [4]. However, these conclusions depend on the assumption that physicians will act differently than managed care companies when faced with the economic imperative of a fully prepaid system in which they are at full financial risk. Implicit in previous criticisms of the efforts of insurance companies to manage medical care is the concern that medical management really means denial of needed services.

It is widely believed that if physicians could control the system and use clinical judgment to steer patients through the maze of diagnostic and therapeutic choices …