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October 2, 1996

Capitation or Decapitation: Keeping Your Head in Changing Times

Author Affiliations

From the Department of Family and Community Medicine (Drs Bodenheimer and Grumbach) and the Institute for Health Policy Studies (Dr Grumbach), University of California, San Francisco.

JAMA. 1996;276(13):1025-1031. doi:10.1001/jama.1996.03540130023011

Violet Fairbanks is disgusted. The meeting, a negotiating session for a physician-hospital managed care agreement, has degenerated into mutual name-calling. Dr George Capwell accuses the hospital of picking his pocket and sending him into financial ruin. Jack Powers, hospital administrator, fingers the physicians as the cause of the hospital's fiscal problems. The meeting ends in chaos. The following morning, the physician leadership of the CapCap Independent Practice Association (IPA) meets. Hitherto, Dr Fairbanks has steered clear of managed care politics. Now, curiosity and mistrust of the hospital and of some physician leaders have brought her to meetings as a spectator. As the CapCap IPA leaders plan their negotiating tactics, Dr Fairbanks timorously raises her hand. "Does it have to be like this? Can't we give in a bit, ask them to give in a bit, get this behind us, and go back to practicing medicine?" She leaves the room at