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April 1, 1998

Defending Health Care: For Patients, Not Profits

Author Affiliations

Margaret A.WinkerMD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Senior EditorIndividualAuthor

JAMA. 1998;279(13):991-992. doi:10-1001/pubs.JAMA-ISSN-0098-7484-279-13-jbk0401

To the Editor.—The call to action by the Ad Hoc Committee to Defend Health Care1 represents physician statesmanship at its best. If we answer the call, it will be our finest hour. If not, we risk the censure of patients and physicians for years to come.

The committee made several recommendations. I would like to reinforce 2 of them. First, there is no place for financial incentives. Years ago, we called such incentives kickbacks and abolished them. We need to control the cost of medical care, but we do not need financial incentives to do it. We can control costs with outcomes analyses and clinical guidelines. Financial incentives undermine our integrity and our patients' confidence in us and make it appear that physicians' primary allegiance is drifting away from patients and toward managed care organizations. In a malpractice suit, financial incentives can be used against physicians, the contention being that financial incentives are self-serving and subordinate patients' health care to the financial goals of their physicians.

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