PEDIATRIC PRACTICE AND LIABILITY RISK IN A MANAGED CARE ENVIRONMENT

Changes in the delivery of health care are inevitable and are being br ought about by medical spending unacceptable to payers and the public. Industry and government demands for cost containment are precipitatin g a transformation of the medical environment from one characterized b y unlimited budgets, fee-for-service reimbursement; and free choice to one of global budgets, prepayment, and substantial limits placed on p atients' and physicians' choices. Such a transformation will increase liability risks for practicing pediatricians. This article provides in formation that may be helpful for pediatricians practicing in a manage d care environment. It begins by discussing why uncontrolled spending is promoting a transition to managed care and how managed care systems seek to influence physician behavior. in addition, information is pre sented concerning health maintenance organization (HMO) contract langu age that may place pediatricians at increased risk and how plan incent ives may affect practice and relationships with patients and colleague s in ways that promote malpractice claiming.