Miller T E, Sage W M
Department of Health Policy, Mount Sinai School of Medicine, New York, NY 10029, USA.
JAMA. 1999 Apr 21;281(15):1424-30. doi: 10.1001/jama.281.15.1424.
Federal and state regulatory initiatives as well as court decisions increasingly require managed care organizations to disclose physician financial incentives and have raised the issue of disclosure by physicians themselves. These mandates are based on ethical and legal principles arising from the patient-physician relationship and the relationship between health plan sponsors and enrollees. Disclosing incentives also serves important policy objectives: it can inform enrollees' choice of plan, reinforce enrollees' capacity to understand and exercise other rights under managed care, and discourage use of compensation methods that might compromise patients' access to treatment. However, significant conceptual and practical questions remain about implementing a disclosure mandate. Unresolved issues include the timing, content, and scope of disclosure, the relationship of disclosure to patients' substantive rights, and the impact of disclosure on trust between patients and physicians. These uncertainties exemplify the challenges facing policymakers, plans, and physicians as they determine how best to inform patients about managed care.
联邦和州的监管举措以及法院判决越来越多地要求管理式医疗组织披露医生的经济激励措施，同时也引发了医生自身披露信息的问题。这些要求基于医患关系以及健康计划赞助商与参保人之间关系所产生的伦理和法律原则。披露激励措施还服务于重要的政策目标：它可以让参保人在选择计划时有所了解，增强参保人理解和行使管理式医疗下其他权利的能力，并抑制可能影响患者获得治疗机会的薪酬支付方式的使用。然而，在实施披露要求方面仍存在重大的概念和实际问题。未解决的问题包括披露的时间、内容和范围，披露与患者实体权利的关系，以及披露对医患之间信任的影响。这些不确定性体现了政策制定者、医疗计划和医生在确定如何以最佳方式告知患者有关管理式医疗信息时所面临的挑战。
