Back to the future: Capitation

Writing in the Boston Globe, Dr. Joseph Dorsey (a former medical director from Harvard Pilgrim) and Dr. Donald Berwick (head of the Institute for Healthcare Improvement) call for a return to managed care, specifically captitation, as a way to control costs and improve quality. See Dirty words in healthcare.
The two of them pine for the old days of Harvard Community Health Plan, with its salaried physicians and emphasis on quality and innovation.

“Managed care” did not mean “restricted care”; it meant “care that makes sense.”

They blame greedy insurance companies and their highly-paid executives for “manag[ing] the money, not the care,” thus leading to a backlash against managed care that washed out the good with the bad. They’d like to see capitation in particular come back.

I agree with them on the benefits of capitation and the idea of getting paid for population management rather than transactions. It’s a movement that’s already underway, including here in Massachusetts.

But it’s a bit much to point the finger at insurance companies for all of our ills. Fact is managed care companies were doing exactly what their employer customers were asking of them: controlling health care costs. In the heyday of managed care they did a good job of it. Physicians certainly hated being dictated to by insurance companies but it doesn’t mean they were completely blameless.

February 27, 2008

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