Federal and state regulatory initiatives as well as court
decisions increasingly require managed care organizations to disclose
physician financial incentives and have raised the issue of disclosure
by physicians themselves. These mandates are based on ethical and legal
principles arising from the patient-physician relationship and the
relationship between health plan sponsors and enrollees. Disclosing
incentives also serves important policy objectives: it can inform
enrollees' choice of plan, reinforce enrollees' capacity to
understand and exercise other rights under managed care, and discourage
use of compensation methods that might compromise patients' access to
treatment. However, significant conceptual and practical questions
remain about implementing a disclosure mandate. Unresolved issues
include the timing, content, and scope of disclosure, the relationship
of disclosure to patients' substantive rights, and the impact of
disclosure on trust between patients and physicians. These
uncertainties exemplify the challenges facing policymakers, plans, and
physicians as they determine how best to inform patients about managed
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