Lessons from managed care.
The infiltration of the health-care environment by health maintenance organizations has been promoted, in part, by instilling fear in physicians about their patient base and creating an illusion of free choice for patients. Within capitation arrangements, specialists are often underpaid for management of complex cases and uncompensated for investment of long hours in ancillary activities. Clinical endocrinologists have been expected to develop algorithms for conditions such as diabetic ketoacidosis, yet application of such guidelines by other clinicians may yield suboptimal results. The transformation of medicine to a business and the focus of insurance administrators on profit rather than high-quality care currently tend to eliminate specialists. Studies that show that high-quality specialty care improves outcomes clinically (and therefore financially) should curb this trend. Nevertheless, a new paradigm for medical care is evolving. Because capitation will not be the only model, clinical endocrinologists should not allow themselves to be exploited in such an arrangement.
Dickey
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RA
Piedmont Endocrinology & Bone Health Center, Hickory, NC 28601, USA.