The impact of physician financial incentives on high-risk populations in managed care.
The challenge of managed care is to design a system in which rules and incentives together create a system of checks and balances that ensure both efficient and high-quality care. Incentives need to be administered so that physicians--both primary care providers and specialists--are not forced to choose between personal and/or organizational financial viability and patients' care. To accomplish this goal, payment needs to be linked both to quality and productivity and appropriately risk-adjusted. Quality assurance programs must ensure that both efficient and high-quality care is being provided and must maintain the satisfaction of both physicians and members. AIDS patients may be harmed by a system in which the more services a physician performs, the more he or she is paid--the traditional way in which American health care has been delivered heretofore. Managed care may undermine the care of high-risk patients if it arbitrarily reduces the high volume of care they require. However, a managed care system with effective checks and balances on financial incentives and quality of care can ensure that an efficient and high standard of care is being met--across all populations, including both healthy and high-risk patients.
Hillman
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Center for Health Policy, Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia 19104.
D000163:Acquired Immunodeficiency Syndrome / Q000191:economics* / Q000628:therapy; D003953:Diagnosis-Related Groups; D005069:Evaluation Studies as Topic; D006305:Health Status Indicators; D006801:Humans; D008329:Managed Care Programs / Q000191:economics* / Q000639:trends; D010816:Physician Incentive Plans / Q000191:economics* / Q000639:trends; D011445:Prospective Payment System; D011787:Quality of Health Care; D012051:Reimbursement Mechanisms; D014481:United States