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June 1997

The Tyranny of CapitationHealth Care in the Belly of the Beast

Author Affiliations

Davis, Calif

Arch Surg. 1997;132(6):579-585. doi:10.1001/archsurg.1997.01430300021003

Capitation (a profit-based form of fixing of health care reimbursement) is the economic force behind private managed care. With capitation, the power over health care provision by managed care administrators has become absolute—a form of tyranny. The results of this misuse are now well documented, but they all lead to the denial of anticipated health care. Managed care may well be the appropriate evolution for our health care provision system. However, since we have come to believe that health care is a right, we must have its provision managed by a strictly nonprofit agency we trust to protect our rights.

DEFINITIONS  Capitation: a system of providing health care whereby payment is advanced for a given population of "clients" or "lives" ("patients" as referred to by the medical profession). Further payment is unavailable, no matter how much medical care might be required. The incentive is for the provider (physician) to withhold

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