In Reply: As we stated in our article, we agree
with Dr Temianka that fee-for-service incentives can lead to inappropriate
treatment and also should be disclosed. Citing numerous studies, we discussed
the challenge presented for requiring mandatory disclosure because existing
data do not provide a definitive conclusion about the relationship between
financial incentives and the quality of health care or the services provided.
At the same time, managed care incentives are less visible to patients
than fee-for-service incentives, less familiar, more complex. Disclosure of
managed care incentives also may have significant consequences for patient
trust and the physician-patient relationship. For all these reasons, disclosure
of managed care incentives demands more attention. Our article sought to inform
consideration of the important issues facing physicians, health plans, and
policymakers as disclosure mandates are implemented across the nation.