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Letters |

Potentially Ineffective Care in Intensive Care

John H. Robinson, MD
JAMA. 1998;279(9):651-654. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-9-jbk0304.
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To the Editor.—The analysis of the effects of reimbursement methods on the rate of PIC by Drs Cher and Lenert1 raises several important and provocative issues. The Editorial2 that accompanied the article raised questions about their methods and suggested that managed care might "encourage the right care for the wrong reason."

There are other issues that were neither addressed in the article nor raised in the Editorial that also may have a bearing on the validity of the conclusions. Managed care reimbursement method is not a unitary phenomenon, and differences among managed care payment methods may have had a significant impact on physician and institutional practices implicated in the study. Also, a conceptual underpinning of capitation reimbursement methods includes incentives to cultivate more holistic and continuous relationships between primary care physicians and their patients that conceivably could provide a more favorable explanation for the observed findings than is feared in the Editorial.

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