Menken M, Goldblatt D, Moxley R T, Hachinski V
Department of Medicine, Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Arch Neurol. 1997 Nov;54(11):1349-50. doi: 10.1001/archneur.1997.00550230026010.
Since the collapse of federal health system reform legislation in 1994, there has been a growing concern with the quality of care provided within managed care systems. Just as physicians practicing under a traditional fee-for-service payment base have financial incentives to do as much as possible for each patient (doing well by doing good), physicians working for managed care plans are sometimes given perverse incentives to do as little as possible. A major quality-related concern among patients and payers (often referred to jointly and ambiguously as consumers of care) is the much larger role assigned to primary care physicians in managed care plans than is usually the case with traditional indemnity insurance.
自1994年联邦医疗体系改革立法失败以来，人们越来越关注管理式医疗体系所提供的医疗服务质量。正如在传统按服务收费支付模式下执业的医生有经济动机为每位患者尽可能多地提供服务（通过做好事来实现自身利益），为管理式医疗计划工作的医生有时会受到反常的激励，尽可能少地提供服务。患者和支付方（通常统称为医疗消费者，但这种称呼有些含混不清）在质量方面主要关注的一个问题是，在管理式医疗计划中，初级保健医生所扮演的角色比传统的赔偿保险中通常的情况要重要得多。
