dr. solomon's dilemma

homesolomon profilefinancial incentivesinterviewscost v. carediscussion
taking a pulse
Is Your Care Costing Your Doctor?
Statistics and Trends on  Financial Risk-Taking by Doctors

Is this practice of doctors bearing financial risk spreading? How likely is it that doctors in your area take part in such a system?
How Does Your Doctor Get Paid?: The Controversy over Capitation

A short, accessible explanation of "capitation"and other methods of paying physicians whereby their incomes are directly affected by their treatment decisions. Hagland addresses what the new medical economics means for patients and doctors, and where the troubled system may be headed.
Bedside Manna: Medicine Turned Upside Down

A compelling article from the American Prospect which traces the "epic reversal" of the principle which guided American medicine for more than 150 years: the practice of medicine should be untainted by financial considerations. Today, however, the principles of Hippocrates are clashing with those of Adam Smith. Reporter Deborah Stone examines this cultural revolution and its impact on doctoring.
The Wonder Drug of Capitation

Medical economist J.D. Kleimke defends capitation. He argues that it's appropriate for some financial risk to fall on doctors because they're in the best position to control spiraling costs. And that it's the best approach for cutting costs while maintaining quality care.
AMA Recommendations

Linking physicians' compensation directly to the level or type of care they provide obviously raises ethical concerns--doctors may find it hard to separate treatment decisions for a particular patient from broader budgetary concerns. Both systems of capitation, which arguably encourage doctors to undertreat, and fee-for-service payment systems, which may encourage overtreatment, can create conflicts of interest. In December 1997, the American Medical Association issued these ethical recommendations for avoiding or addressing possible conflicts.
Ethical Guidelines for Physician Compensation Based On Capitation

This essay from the New England Journal of Medicine proposes a set of principles by which to achieve more cost-conscious and effective care without jeopardizing the integrity of physicians' decisions regarding care for individual patients. Despite the conflicts of interest that can arise under capitation, the authors believe that it is possible to negotiate "morally acceptable" contracts.
Glossary

The world of managed care and health care finance has its own sometimes complicated terminology. This glossary, from the Alliance for Health Reform, is a helpful guide.


See our links page for more readings on capitation.


home · inside the dilemma · financial incentives · interviews · cost v. care
discussion · ask the producer · producer's notebook · links · tapes & transcripts · synopsis

web site copyright 1995-2014 WGBH educational foundation

SUPPORT PROVIDED BY

FRONTLINE on

ShopPBS