Physicians' ethical beliefs about cost-control arrangements

Archives of Internal Medicine

Volumn 160, Issue 5, 2000, Pages 649-657

  Sulmasy, Daniel P ^a,b   Bloche, M Gregg ^c   Mitchell, Jean M ^d,e   Hadley, Jack ^e  

^a ST VINCENT S HOSPITAL   (United States)

^b NEW YORK MEDICAL COLLEGE   (United States)

^c GEORGETOWN UNIVERSITY LAW CENTER   (United States)

^d GEORGETOWN UNIVERSITY SCHOOL OF MEDICINE   (United States)

^e GEORGETOWN UNIVERSITY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CAREER; COST CONTROL; DOCTOR PATIENT RELATION; FINANCIAL MANAGEMENT; HEALTH CARE FINANCING; HEALTH CARE SYSTEM; MEDICAL DECISION MAKING; MEDICAL ETHICS; MORALITY; MULTIPLE REGRESSION; PHYSICIAN ATTITUDE; PRACTICE GUIDELINE; PRIORITY JOURNAL; UNITED STATES;

EID: 0034642959     PISSN: 00039926     EISSN: None     Source Type: Journal    
DOI: 10.1001/archinte.160.5.649     Document Type: Article

References (68)

1. Gold MR, Hurley R, Lake T, Ensor T, Berenson R. A national survey of the arrangements managed-care plans make with physicians. N Engl J Med. 1995;25: 1678-1683.
2. Hillman A, Welch WP, Pauly M. Contractual arrangements between HMDs and primary care physicians: three-tiered HMOs and risk pools. Med Care. 1992;30: 136-148.
3. Bodenheirner TS, Grumbach K. Capitation or decapitation: keeping your head in changing times. JAMA 1996;13:1025-1031.
4. Schlesinger MJ, Gray BH, Perreira KM. Medical professionalism under managed care: the pros and cons of utilization review. Health Aff (Millwood). 1996; 1:106-124.
5. Hanchak NA, Schlackman N, Harmon-Weiss S. US Healthcare's quality-based compensation model. Health Care Financ Rev. 1996;3:143-156.
6. Bodenheimer T, Grumbach K. The reconfiguration of US medicine. JAMA. 1995; 1:85-90.
7. Robinson JC, Casalino LP. The growth of medical groups paid through capitation in California. N Engl J Med. 1995;25:1684-1687.
8. Kwon S. Structure of financial incentive systems for providers in managed care plans. Med Care Res Rev. 1996;2:149-156.
9. Halm EA, Causino N, Blumenthal D. Is gatekeeping better than traditional care? JAMA. 1997;20:1677-1681.
10. Franks P, Clancy CM, Nutting PA. Gatekeeping revisited: protecting patients from overtreatment. N Engl J Med. 1992;6:424-429.
11. General Accounting Office. Managed Care: Explicit "Gag Clauses" Not Found in HMO Contracts, but Concerns Remain. Washington, DC: US General Accounting Office; August 1997. Report GAO-HEHS-97-175.
12. Himmelstein DU, Woolhandler S. Bound to gag. Arch Intern Med. 1997;157: 2033-2037.
13. Enthoven A, Kronick R. A consumer-choice health plan for the 1990s. N Engl J Med. 1989;320:29-37, 94-100.
14. Havighurst CC. Health Care Choices, Private Contracts as Instruments of Health Reform. Washington DC: AEI Press; 1995.
15. Eddy DM. Balancing cost and quality in fee-for-service versus managed care. Health Aff (Millwood). 1997;3:162-173.
16. Morreim EH. Balancing Act: The New Medical Ethics of Medicine's New Economics. Washington, DC: Georgetown University Press; 1995:139-145.
17. Berenson RA. A physician's view of managed care. Health Aff (Millwood). 1991; 10:106-119.
18. Welch HG, Bernat JL, Mogielnicki RP. Who's in charge here? maximizing patient benefit and professional authority by physician limit setting. J Gen Intern Med. 1994;9:450-454.
19. Morreim EH. Fiscal scarcity and the inevitability of bedside rationing. Arch Intern Med. 1988;149:1012-1015.
20. Ubel PA, Arnold RM. The unbearable rightness of bedside rationing. Arch Intern Med. 1995;155:1837-1842.
21. Hippocrates. Oath. In: Jones WHS. Hippocrates. Vol 1. Cambridge, Mass: Harvard University Press; 1923:298-301.
22. Bloche MG. Clinical loyalties and the social purposes of medicine. JAMA. 1999; 281:268-274.
23. Arrow K. Uncertainty and the welfare economics of medical care. Am Econ Rev. 1963;5:941-973.
24. Parsons T. The Social System. New York, NY: Free Press; 1964.
25. Kass L. Toward a More Natural Science. New York, NY: Free Press; 1985.
26. Orentlicher D. Paying physicians more to do less: financial incentives to limit care. Univ Richmond Law Rev. 1996;30:155-197.
27. La Puma J. Managed Care Ethics: Essays on the Impact of Managed Care on Traditional Medical Ethics. New York, NY: Hatherleigh Press; 1998:14-150.
28. Brody H. Cost-containment as a professional challenge. Theor Med. 1987;8:5-17.
29. Goold SD. Allocating health care: cost-utility analysis, informed democratic decision making, or the veil of ignorance? J Health Polit Policy Law. 1995;21:69-98.
30. Bloche MG. Cutting waste and keeping faith. Ann Intern Med. 1998;128:688-689.
31. Sulmasy DP. Physicians, cost-control and ethics, Ann Intern Med. 1992;116: 920-926.
32. Pellegrino ED. Rationing health care: the ethics of moral gatekeeping. J Contemp Health Law Policy. 1986;2:23-45.
33. Mechanic D, Schlesinger M. The impact of managed care on patients' trust in medical care and their physicians. JAMA. 1996;275:1693-1697.
34. Kassirer JP. Managed care and the morality of the marketplace. N Engl J Med. 1995;333:50-52.
35. Angell M. The doctor as double agent. Kennedy Inst Ethics J. 1993;3:279-286.
36. Hillman AL, Pauly MV, Kerstein JJ. How do financial incentives affect physicians' clinical decisions and the financial performance of health maintenance organizations? N Engl J Med. 1989;2:86-92.
37. Kerr EA, Hays RD, Mittman BS, Siu AL, Leake B, Brook RH. Primary care physicians' satisfaction with quality of care in California capitated medical groups. JAMA. 1997;4:308-312.
38. Conrad DA, Maynard C, Cheadle A, et al. Primary care physician compensation method in medical groups: does it influence the use and cost of health services for enrollees in managed care organizations? JAMA. 1998;11:853-858.
39. Farley DO. Competition under fixed prices: effects on patient selection and service: strategies by hemodialysis providers. Med Care Res Rev. 1996;3:330-340.
40. Hellinger FJ. The impact of financial incentives on physician behavior in managed care plans: a review of the evidence. Med Care Res Rev. 1996;3:294-307.
41. Grembowski DE, Cook K, Patrick DL, Roussel AE. Managed care and physician referral. Med Care Res Rev. 1998;1:3-22.
42. Cantor JC, Baker LC, Hughes RG. Preparedness for practice: young physicians' views of their professional education. JAMA. 1993;270:1035-1040.
43. Tversky A, Kahneman D. The framing of decisions and the psychology of choice. Science. 1981;211:453-458.
44. Mitchell JM, Hadley J, Sulmasy DP, Bloche MG. Measuring the effects of managed care on physicians' personal financial incentives. Inquiry. In press.
45. Jecker NS, Jonsen AR. Managed care: a house of mirrors. J Clin Ethics. 1997; 8:230-241.
46. Robinson JC, Casalino LP. The growth of medical groups paid through capitation in California. N Engl J Med. 1995;333:416-425.
47. Conrad DA, Maynard C, Cheadle A, et al. Primary care physician compensation method in medical groups: does it influence the use and cost of health services for enrollees in managed care organizations? JAMA. 1998;297:853-858.
48. Hillman AL, Pauly MV, Kerstein JJ. How do financial incentives affect physicians' clinical decisions and the performance of health maintenance organizations? N Engl J Med. 1989;321:86-92.
49. Donelan K, Blendon RJ, Lundberg GD, et al. The new medical marketplace: physicians' views. Health Aff (Millwood). 1997;16:139-148.
50. Grumbach K, Osmond D, Vranizan K, Jaffe D, Bindman AB. Primary care physicians' experience of financial incentives in managed care systems, N Engl J Med. 1998;339:1516-1521.
51. Pellegrino ED. Altruism, self-interest, and medical ethics. JAMA. 1987;258:1939-1940.
52. Flexner A. Is social work a profession? School Soc. 1915;26:901-911.
53. Feldman DS, Novack DH, Gracely E. Effects of managed care on physician-patient relationships, quality of care, and the ethical practice of medicine. Arch Intern Med. 1998;158:1626-1632.
54. Gilligan C. In a Different Voice: Psychological Theory and Women's Development. Cambridge, Mass: Harvard University Press; 1982.
55. Brody H, Bonham VL. Gag rules and trade secrets in managed care contracts: ethical and legal concerns. Arch Intern Med. 1997;157:2037-2043.
56. Inouye J, Kristopatis R, Stone E, Pelter M, Sandhu M, Weingarten S. Physicians' changing attitudes toward guidelines. J Gen Intern Med. 1998;13:324-326.
57. Berger JT, Rosner F, The ethics of practice guidelines. Arch Intern Med. 1996; 156:2051-2056.
58. Loewy E. Guidelines, managed care, and ethics. Arch Intern Med. 1996;156: 2038-2040.
59. Pellegrino ED, Thomasma DC. For the Patient's Good: the Restoration of Beneficence in Medical Ethics. New York, NY: Oxford University Press; 1989;54-55, 109-110.
60. Mechanic D, Ettel T, Davis D. Choosing among health care options. Inquiry. 1990; 27:14-23.
61. St Peter RF. Access to Specialists: Perspectives of Patients and Primary Care Physicians [data bulletin]. Washington, DC: Center for Studying Health System Change; Fall 1997:1-2.
62. Kao AC, Green DC, Zaslevsky AM, Koplan JP, Cleary PD. The relationship between method of physician payment and patient trust. JAMA. 1998;280:1708-1714.
63. Williams B. A critique of utilitarianism. In: Smart JJC, Williams B. Utilitarianism: For and Against. New York, NY: Cambridge University Press; 1973:77-150.
64. Weinstein ML. Capitation: theory, practice, and evaluating rates for gastroenterology. Gastroenterol Clin North Am. 1997;26:773-784.
65. Mechanic D. Public trust and initiatives for new health care partnerships. Milbank Q. 1998;76:281-302.
66. Gray BH. Trust and trustworthy care in the managed care era. Health Aff (Millwood). 1997;16:34-49.
67. Kuttner R. Must good HMDs go bad? N Engl J Med. 1998;338:1558-1563, 1635-1639.
68. Kassirer JP. Managing care: should we adopt a new ethic? N Engl J Med. 1998; 339:397-398.