During the 1990s and continuing today, the public and the media focused heavily on the ethics of physician compensation plans such as capitation, in which physicians receive a lump sum for each patient they manage, according to background information in the article. "Commentaries by physicians, media reports, editorial cartoons and even popular movies raised alarms that these new physician payment methods were creating hazardous conflicts of interest that would keep physicians from recommending expensive, but necessary, care," the authors write. "This increasing suspicion about financial incentives spawned individual and class action lawsuits, and was a prominent part of the managed care 'backlash'." Some have suggested financial disclosures as a solution, but opponents worry that sharing such information with patients could undermine trust without helping them make decisions about their health care.
Steven D. Pearson, M.Sc., M.D., Harvard Medical School and Harvard Pilgrim Health Care, Boston, and colleagues studied the effects of such disclosures at two group practices, one in Boston (5,000 patients) and one in Los Angeles (3,000 patients). The chief medical officer of each physician group drafted a letter explaining the basic model by which physicians in the group were compensated--mentioning, for instance, that the group receives money from many health insurers, which is pooled and then distributed to physicians as monthly or bimonthly salaries based on a number of factors. Patients at the two group practices were randomized and half were sent a disclosure letter. About eight to 12 weeks later, all the patients were mailed a
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