PubMed HealthSearch

PubMed · 10111362

Serving two masters: conflicts in practice.

Abstract

Accustomed to putting patients' needs first, internists now face daily pressure to contain health care costs. With a view from the trenches, a practicing internist and former ASIM president enumerates the dilemmas physicians confront in trying to serve patients and payers.

Explore related subjects

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

T R Harris. 1991. Serving two masters: conflicts in practice.. https://pubmed.ncbi.nlm.nih.gov/10111362/

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

Distributive justice in Medicaid capitation: the evidence from Colorado.

In 1995, the state of Colorado began a new funding program for the provision of mental health services to Medicaid recipients. Medicaid funding was restructured from a fee-for-service system into a capitated managed care system. The restructuring altered the way in which mental health resources were allocated within Colorado's mental health system. This article explores the ethical principles inherent in the allocation of mental health resources within Colorado. The allocation system before and after the capitation pilot is analyzed according to three models of distributive justice. Under capitation, access to care corresponds to egalitarian ideals, while service delivery and outcomes follow a more utilitarian philosophy. Results from several empirical studies of the Colorado Medicaid system are used to support this ethical analysis. The analysis leads to the suggestion that the fair-opportunity rule may be a useful principle for developing just distribution systems in other states in the future.

Capitation Fee

The response of providers to capitation payment: a case-study from Thailand.

Those designing payment systems for health care in low and middle income countries are increasingly looking to capitation payment, in order to avoid the cost inflation experienced with fee-for-service payment. However, there is virtually no documentation of the experience of introducing capitation payment, or of its effects. This paper draws on several research studies to explore responses by health care providers at both the market and facility level to the introduction of capitation payment, in the context of a new compulsory insurance scheme for workers in Thailand. The paper ends by identifying lessons for both Thailand itself and for other countries.

Capitation Fee