To the Editor.
—Drs Mechanic and Schlesinger1 articulate a utopian vision of medical practice that I would like to see practiced widely. Most physicians would—plans would take responsibility and financial risk, regulatory agencies would disclose incentives, and physicians would keep autonomy and rewards.Yet this vision pales in the light of facts. Patients already think physicians are paid too much, even while underestimating their incomes by half.2 Two thirds of patients and physicians believe some physicians would enroll patients in research just for the fee.3 Physician utilization managers act no differently than nonphysician insurance managers.4 Many physicians actually want to take the financial risk of capitation so they can maintain control of care and its rewards.5To keep the interpersonal trust that individual patients still extend to their own physicians, policymakers and executives should motivate physicians financially to achieve patients' personal medical desires.It is
La Puma J. Professionalism in Medicine: Can Patients Trust in Managed Care? JAMA. 1996;276(12):951. doi:10.1001/jama.1996.03540120029020
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