Managing Care — Should We Adopt a New Ethic?

The reorganization of health care is profoundly influencing the roles, responsibilities, and even the loyalties of physicians. The accelerated disappearance of the solo practitioner has been matched by an increase in the number of physicians who belong to various complex organizational groupings, including independent practice associations (IPAs), physician–hospital organizations (PHOs), and group- and staff-model health maintenance organizations (HMOs). No matter what the physician reimbursement mechanism is in each plan (fee-for-service or global capitation), plan administrators expect individual physicians or groups of physicians to stay within a fixed budget for their panels of patients. To achieve this goal, many try to . . .