Sunday, March 02, 2008

My Letter to the Editor

Early last week The Boston Globe carried an Op-Ed column by Drs. Joe Dorsey and Don Berwick extolling the virtues of capitation – the system in which the health insurance company pays for the care of a subscriber by remitting a fixed and predetermined amount per month to a provider organization. Dorsey and Berwick fondly recalled their early days as practicing physicians employed by the Harvard Community Health Plan (HCHP), one of the early HMOs financed by capitation. Dorsey became Medical Director of HCHP and Berwick is a founder and renowned head of the Institute for Healthcare Improvement.

The point emphasized by the authors was that under capitation they were free as physicians to do what they believed to be best for the patient without worrying about the complexities of payment.

Those were the days of managed care, which the column referred to as having been “hijacked” by insurance companies.

That reference stimulated me to send the following letter to the editor:

“I agree with Dorsey and Berwick that capitation is the best way to pay providers of health care. However, their accusation that insurance companies "hijacked" managed healthcare is unfair. The detested interference by those companies in medical decision-making was in response to the failure of provider organizations to prevent the unnecessary use of expensive services. Or, to put it in fewer words, to the failure of providers to manage care. Like Dorsey and Berwick, I think capitation ought to be tried again. But it will succeed only if providers are able and willing to be effective managers of care.”

The Globe published my letter, along with several others relating to health care, in its Sunday, March 2 edition

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