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CareGroup CEO James Reinertsen believes that the crisis in financing health
care must be addressed, at least in part, by the health consumer bearing a
greater financial responsibility for his or her own care.
Medical economist J.D. Kleimke defends capitation (the payment system which
assigns a monthly flat fee to a doctor/medical group/hospital, for taking care
of a patient enrolled in a managed health care plan, regardless of the cost of
that patient's care.) Kleimke argues that it's appropriate for some financial
risk to fall on doctors because they're best able to control spiraling costs
and have a vested interest in maintaining their patient's health.
During the rise of managed care in the 1990s, the financial risk of patient
care became a hot potato--passed back and forth between HMOs and doctors,
medical groups and hospitals. Tom Jennings, field producer for "Dr. Solomon's
Dilemma," examines the battle that took place in Boston.
This New England Journal of Medicine article by Robert Kuttner examines
the checks and balances within a market-based health care system that may help
prevent professional ethics and patient care from being compromised. For
example, theoretically, consumers discipline health plans and providers by
choosing among competing plans. And many states have implemented some form of
health consumer protection legislation and other regulations. Kuttner
concludes, however, that while "in principle, checks and balances are possible
to prevent the less scrupulous HMOs from leading a competitive 'race to the
bottom,'" in practice, these mechanisms are so complex and create such
bureaucratic hurdles that they are unlikely to succeed.
This editorial from the New England Journal of Medicine argues against a
fundamental premise of managed care: the idea that medicine should be subject
to the same market forces as any other business. Writing in 1995, the author
predicted that this "wrongheaded philosophy of health care" would ultimately
"alienate physicians, undermine patients' trust of physicians' motives, cripple
academic medical centers, handicap the research establishment, and expand the
population of patients without health care coverage."
Until recently, it was almost universally accepted that commercial managed care
had effectively taken control of the medical market, despite the protests of
physicians and consumers over what some considered impersonal and draconian
cost-cutting measures. In this February 1999 article from the New England
Journal of Medicine, Dr. Thomas Bodenheimer argues that perhaps the battle
is not entirely over: "In the past two years, a reversal has taken place....The
value of HMO stocks has tumbled. . . . The control exercised by managed care
over clinical decisions is weakening. . . . Suddenly, the outcome of the
contest between physicians and managed-care plans is uncertain. "
inside the dilemma ·
financial incentive ·
cost v. care
ask the producer ·
producer's notebook ·
tapes & transcripts ·