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November 6, 1996, Vol 276, No. 17 >
ARTICLE | November 6, 1996

The Oregon Capitation Initiative: Title and subTitle BreakLessons and Warnings, From the Forefront of the Backlash FREE

Matthew K. Wynia, MD
[+] Author Affiliations

Reprints: Matthew K. Wynia, MD, Division of Clinical Care Research, New England Medical Center, 750 Washington St, No. 63, Boston, MA 02111 (e-mail: matt.wynia@es.nemc.org).


JAMA. 1996;276(17):1441-1444. doi:10.1001/jama.1996.03540170085043
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References

FINANCIAL INCENTIVES that influence physician decision making are unavoidable.1 Under the traditional fee-for-service system of physician payment, services that provide benefit to the patient also hold the promise of additional revenue for the physician. In conjunction with health insurance, this payment system strongly promotes increased use of resources,2 and many health economists believe that fee-for-service payment of physicians has been a major contributor to the rapid growth in health care costs in the United States.3

With annual rates of growth in health care expenditures continuing to outstrip the rate of growth of the economy, business and government have turned to alterations in physicians' financial incentives to assist in limiting health care expenditures.4 In particular, managed care plans using capitated payments to physicians are becoming more common.5 Under capitation, in its simplest form, physicians, either individually or in a group, receive a fixed payment

REFERENCES

1 +
Rodwin MA. Medicine, Money, and Morals: Physicians' Conflicts of Interest . New York, NY: Oxford University Press; 1993;.
2 +
Pauly M.  A primer on competition in medical markets . In: Frech HE I, ed. Health Care in America . San Francisco, Calif: Pacific Research Institute of Public Policy; 1988;:27-71.
3 +
Newhouse JP.  Medical care costs: how much welfare loss? J Econ Perspect . 1992;;6:3-21.
4 +
Gold MR, Hurley R, Lake Y, Ensor T, Berenson R.  A national survey of the arrangements managed-care plans make with physicians . N Engl J Med . 1995;;333:1678-1683.
5 +
Bodenheimer T, Grumbach K.  The reconfiguration of US medicine . JAMA . 1995;;274:85-90.
6 +
Woolhandler S, Himmelstein DU.  Extreme risk—the new corporate proposition for physicians . N Engl J Med . 1995;;333:1706-1708.
7 +
Hillman AL.  Financial incentives for physicians in HMOs: is there a conflict of interest? N Engl J Med . 1987;;317:1743-1748.
8 +
Pauly MV, Eisenberg JM, Radany MH, Erder MH, Feldman R, Schwartz JS.  Capitation with or without financial incentives . In: Paying Physicians: Options for Controlling Cost, Volume, and Intensity of Services . Ann Arbor, Mich: Health Administration Press; 1992;:101-116.
9 +
Selker H.  Capitated payment for medical care and the role of the physician . Ann Intern Med . 1996;;124:449-451.
10 +
Council on Ethical and Judicial Affairs, American Medical Association.  Ethical issues in managed care . JAMA . 1995;;273:330-335.
11 +
Emanuel EJ, Dubler NN.  Preserving the physician-patient relationship in the era of managed care . JAMA . 1995;;273:323-329.
12 +
Grannemann TW.  Priority setting: a sensible approach to Medicaid policy? Inquiry . 1991;;28:300-305.
13 +
Page L.  Ophthalmologist asks Oregon voters to outlaw capitation . Am Med News . (August 26) , 1996;;39:3, 20.
14 +
Holohan J, Coughlin T, Leighton K, Lipson DJ, Rajan S.  Insuring the poor through Section 1115 Medicaid waivers . Health Aff (Millwood) . (Spring) 1995;;14:199-216.
15 +
Spragins EE.  Health care: beware your HMO . Newsweek . (October 23) ,1995;:54-56.
16 +
Larson E.  What your doctor can't tell you: the soul of an HMO . Time . (January 23) , 1996;:44-52.
17 +
O'Neill P.  Doctor fee plan may cure high costs, but opponents decry side effects . The Oregonian . (September 25) , 1996;:1.
18 +
Dolnick E.  Death by HMO: what killed Karin Smith? Glamour . February 1996;;94( (2) ):158.
19 +
Sherman W.  Mismanaged care . Vogue . February 1996;;186( (2) ):154-155.
20 +
Bilchik GS.  Under scrutiny . Hosp Health Netw . 1996;;5:24-31.
21 +
Crawshaw R, Rogers DE, Pellegrino ED, et al.  Patient-physician covenant . JAMA . 1995;;273:1553.
22 +
Kaplan SH, Greenfield S, Ware JE.  Assessing the effects of physician-patient interactions on the outcomes of chronic disease . Med Care . 1989;;27:s110-s127.
23 +
Wennberg J, Gittelsohn A.  Variations in medical care among small areas . Sci Am . 1982;;246( (4) ):120-134.
24 +
Hemenway D, Killen A, Cashman SB, Parks CL, Bicknell WJ.  Physicians' response to financial incentives: evidence from a for-profit ambulatory care center . N Engl J Med . 1990;;322:1059-1063.
25 +
Wynia MK. Economic analyses, patients' dilemmas, and the medical commons: what is the physician's role? J Investig Med. In press.
26 +
 HMO's gear up for initiative petitions . Oregon Health Forum . 1996;;6:1.
27 +
Miller RH, Luft HS.  Managed care plan performance since 1980 . JAMA . 1994;;271:1512-1519.
28 +
Emanuel EJ, Emanuel LL.  What is accountability in health care? Ann Intern Med . 1996;;124:229-239.
29 +
Hughes J.  Doctors are dinosaurs in a high tech world . New York Newsday . (July 1) , 1995;.
30 +
Kassirer JP.  Managed care and the morality of the marketplace . N Engl J Med . 1995;;333:50-52.
31 +
Cassel CK.  The patient-physician covenant: an affirmation of Asklepios . Ann Intern Med . 1996;;124:604-606.
32 +
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;;321:86-92.
33 +
Pearson SD, Lee TH, Lindsey E, Hawkins T, Cook EF, Goldman L.  The impact of membership in a health maintenance organization on hospital admission rates for acute chest pain . Health Serv Res . 1994;;29:59-74.
34 +
Monroe LR.  Consumers lead the charge against HMOs: how HMOs pay physicians . Oregon Health Forum . 1996;;6:10-12.
35 +
Swartz K, Brennan TA.  Integrated health care, capitated payment, and quality: the role of regulation . Ann Intern Med . 1996;;124:442-448.
36 +
Health Care Financing Administration. Medicare and Medicaid programs: requirements for physician incentive plans in prepaid health care organizations. 42 CFR §417, 434, April 12, 1996.
37 +
Todd JS.  Must the law assure ethical behavior? JAMA . 1992;;268:98.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Rodwin MA. Medicine, Money, and Morals: Physicians' Conflicts of Interest . New York, NY: Oxford University Press; 1993;.
2 +
Pauly M.  A primer on competition in medical markets . In: Frech HE I, ed. Health Care in America . San Francisco, Calif: Pacific Research Institute of Public Policy; 1988;:27-71.
3 +
Newhouse JP.  Medical care costs: how much welfare loss? J Econ Perspect . 1992;;6:3-21.
4 +
Gold MR, Hurley R, Lake Y, Ensor T, Berenson R.  A national survey of the arrangements managed-care plans make with physicians . N Engl J Med . 1995;;333:1678-1683.
5 +
Bodenheimer T, Grumbach K.  The reconfiguration of US medicine . JAMA . 1995;;274:85-90.
6 +
Woolhandler S, Himmelstein DU.  Extreme risk—the new corporate proposition for physicians . N Engl J Med . 1995;;333:1706-1708.
7 +
Hillman AL.  Financial incentives for physicians in HMOs: is there a conflict of interest? N Engl J Med . 1987;;317:1743-1748.
8 +
Pauly MV, Eisenberg JM, Radany MH, Erder MH, Feldman R, Schwartz JS.  Capitation with or without financial incentives . In: Paying Physicians: Options for Controlling Cost, Volume, and Intensity of Services . Ann Arbor, Mich: Health Administration Press; 1992;:101-116.
9 +
Selker H.  Capitated payment for medical care and the role of the physician . Ann Intern Med . 1996;;124:449-451.
10 +
Council on Ethical and Judicial Affairs, American Medical Association.  Ethical issues in managed care . JAMA . 1995;;273:330-335.
11 +
Emanuel EJ, Dubler NN.  Preserving the physician-patient relationship in the era of managed care . JAMA . 1995;;273:323-329.
12 +
Grannemann TW.  Priority setting: a sensible approach to Medicaid policy? Inquiry . 1991;;28:300-305.
13 +
Page L.  Ophthalmologist asks Oregon voters to outlaw capitation . Am Med News . (August 26) , 1996;;39:3, 20.
14 +
Holohan J, Coughlin T, Leighton K, Lipson DJ, Rajan S.  Insuring the poor through Section 1115 Medicaid waivers . Health Aff (Millwood) . (Spring) 1995;;14:199-216.
15 +
Spragins EE.  Health care: beware your HMO . Newsweek . (October 23) ,1995;:54-56.
16 +
Larson E.  What your doctor can't tell you: the soul of an HMO . Time . (January 23) , 1996;:44-52.
17 +
O'Neill P.  Doctor fee plan may cure high costs, but opponents decry side effects . The Oregonian . (September 25) , 1996;:1.
18 +
Dolnick E.  Death by HMO: what killed Karin Smith? Glamour . February 1996;;94( (2) ):158.
19 +
Sherman W.  Mismanaged care . Vogue . February 1996;;186( (2) ):154-155.
20 +
Bilchik GS.  Under scrutiny . Hosp Health Netw . 1996;;5:24-31.
21 +
Crawshaw R, Rogers DE, Pellegrino ED, et al.  Patient-physician covenant . JAMA . 1995;;273:1553.
22 +
Kaplan SH, Greenfield S, Ware JE.  Assessing the effects of physician-patient interactions on the outcomes of chronic disease . Med Care . 1989;;27:s110-s127.
23 +
Wennberg J, Gittelsohn A.  Variations in medical care among small areas . Sci Am . 1982;;246( (4) ):120-134.
24 +
Hemenway D, Killen A, Cashman SB, Parks CL, Bicknell WJ.  Physicians' response to financial incentives: evidence from a for-profit ambulatory care center . N Engl J Med . 1990;;322:1059-1063.
25 +
Wynia MK. Economic analyses, patients' dilemmas, and the medical commons: what is the physician's role? J Investig Med. In press.
26 +
 HMO's gear up for initiative petitions . Oregon Health Forum . 1996;;6:1.
27 +
Miller RH, Luft HS.  Managed care plan performance since 1980 . JAMA . 1994;;271:1512-1519.
28 +
Emanuel EJ, Emanuel LL.  What is accountability in health care? Ann Intern Med . 1996;;124:229-239.
29 +
Hughes J.  Doctors are dinosaurs in a high tech world . New York Newsday . (July 1) , 1995;.
30 +
Kassirer JP.  Managed care and the morality of the marketplace . N Engl J Med . 1995;;333:50-52.
31 +
Cassel CK.  The patient-physician covenant: an affirmation of Asklepios . Ann Intern Med . 1996;;124:604-606.
32 +
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;;321:86-92.
33 +
Pearson SD, Lee TH, Lindsey E, Hawkins T, Cook EF, Goldman L.  The impact of membership in a health maintenance organization on hospital admission rates for acute chest pain . Health Serv Res . 1994;;29:59-74.
34 +
Monroe LR.  Consumers lead the charge against HMOs: how HMOs pay physicians . Oregon Health Forum . 1996;;6:10-12.
35 +
Swartz K, Brennan TA.  Integrated health care, capitated payment, and quality: the role of regulation . Ann Intern Med . 1996;;124:442-448.
36 +
Health Care Financing Administration. Medicare and Medicaid programs: requirements for physician incentive plans in prepaid health care organizations. 42 CFR §417, 434, April 12, 1996.
37 +
Todd JS.  Must the law assure ethical behavior? JAMA . 1992;;268:98.

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