Cost-containment incentives in HMOs. What's known, what's not known.

HMOs use various incentives to control utilization of health care resources, and physicians who are thinking of joining these organizations should understand how these factors will influence their practice. Financial incentives include withheld funds, penalties against those at risk, and bonuses for physicians with good practice habits. Nonfinancial incentives include education concerning efficient use of health care resources, feedback mechanisms, participation in planning cost-containment programs, and administrative constraints. There are also less obvious, nonfinancial incentives; one involves inclusion of ancillary office personnel in bonus distribution, and these individuals may thus influence a physician's prescribing habits.