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August 23, 1995

Managed Care: Ethical Issues-Reply

Author Affiliations

Dana-Farber Cancer Institute Boston, Mass
Albert Einstein College of Medicine Bronx, NY

JAMA. 1995;274(8):610-611. doi:10.1001/jama.1995.03530080025028

In Reply.  —We agree with Dr Doner that the physician-patient relationship itself can be therapeutic. We tried to incorporate this into our notion of compassion as an essential element of the physician-patient relationship. We appreciate her focus on this issue.We agree with Dr Rosner that minimizing financial conflicts of interest is essential to an ideal physician-patient relationship. But we urge caution in criticism of managed care plans since fee-for-service medicine has its own financial conflicts of interest in which physicians personally benefit by doing too much. The consequences of these conflicts are well documented.1 Many managed care plans do use financial incentives that make physicians "double agents."2,3 For instance, 60% of managed care plans withhold more than 10% of physicians' income and 35% provide salary bonuses for limiting use of expensive medical treatments and consultations. Nevertheless, some managed care plans have been careful to avoid financial conflicts