Health maintenance organizations and physicians: impact and response

The considerable growth of health maintenance organizations is significantly changing the traditional systems under which physicians have historically practiced medicine. Allowable cost reimbursement, fee-for-service payment, and private practice are being confronted with the spread of HMOs and the shift of physicians to capitated payment systems or salaried employment status. The disruption in physicians' work lives has led to a number of collective responses including militant resistance to HMOs, the creation of physician-controlled HMOs, affiliation with union-like mutual benefit organizations, and the establishment of physician labor unions. This paper examines the impact of these changes on physicians and the nature and likely success of the responses being made.