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Related Experiment Videos

How should managed care physicians be paid?

R Pagano1

  • 1Travelers Health Company, Hartford, CT.

Physician Executive
|August 6, 1994
PubMed
Summary
This summary is machine-generated.

Most patients expect a bill for medical services, not prepaid care. Managed health care systems, including PPOs, IPAs, and HMOs, often use capitation payments, a shift from traditional fee-for-service models.

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Area of Science:

  • Health Economics
  • Medical Policy

Background:

  • Patients typically expect to pay for medical services after they are rendered.
  • Health insurance premiums are common, but prepaid healthcare is less understood by the public.
  • Managed care systems represent a significant shift in healthcare payment models.

Purpose of the Study:

  • To explain the concept of prepaid medicine in managed healthcare systems.
  • To describe common payment structures within managed care organizations.
  • To highlight the evolving nature of physician compensation in healthcare.

Main Methods:

  • Analysis of managed care organization structures.
  • Review of payment models such as capitation and discounted professional fees.
  • Examination of the evolution of physician compensation strategies.

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Main Results:

  • Managed care organizations (PPOs, IPAs, HMOs) often operate on a prepaid, or capitation, payment model.
  • Providers may also contract with insurers for predetermined, discounted professional fees.
  • Physician compensation methods within managed care have undergone significant evolution.

Conclusions:

  • Managed healthcare fundamentally relies on prepaid medicine, contrasting with traditional patient billing.
  • Various payment mechanisms, including capitation and contracted fees, are employed by managed care organizations.
  • Physician compensation models are dynamic and continue to evolve within the managed care landscape.