Managed care is moving West to East, as noted in the article by Lazarus in the December 1994 issue of the Archives.1 California is 75% managed care, and 35% fully capitated. It took Minnesota the better part of 10 years to reach fourth, or end-stage managed care (capitation). It has taken California, the nation-state, 2.5 years so far. My personal prediction is now for full capitation within 18 to 24 months based on the gargantuan inroads capitation has made in the California metropolitan regions of Los Angeles and the San Francisco Bay and San Diego areas. San Diego has already felt the squeeze, with some dermatologists going elsewhere 1 week or so per month to nonserved areas in order to supplement their income.
Stanton DL. Rx: Capitation... a Bitter Pill for the Near Future: 2400 American Dermatologists in the Year 2000? Arch Dermatol. 1996;132(4):387–389. doi:10.1001/archderm.1996.03890280039006
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