PHYSICIANS VIEWS ON CAPITATED PAYMENT FOR MEDICAL-CARE - DOES FAMILIARITY FOSTER ACCEPTANCE

Physicians' attitudes toward capitated payment have not been quantifie d. We sought to assess physicians' views on capitated payment and to c ompare the views of those who did and did not participate in such paym ent. A written survey was given to 200 physicians with admitting privi leges at a 600-bed Ohio hospital; 82 (41%) responded and were included in this study. Among respondents, 21 (26%) were primary care physicia ns, 18 (22%) were medical subspecialists, and 18 (22%) were surgeons. Fifty-eight (71%) were providers for managed care plans, and 35 (43%) participated in capitated payment arrangements. Among physicians who d id not participate in capitated care, 100% believed that there was a c onflict of interest in capitated payment, and 77% (23 physicians) beli eved that participation in plans that reduce physician income in propo rtion to medical expenditures is not acceptable. Among those who did p articipate in capitated payment contracts, 95% (41 physicians) believe d these plans posed a conflict of interest, and 72% (31 physicians) sa id this was not acceptable; (P=0.4 and 0.66 for each comparison). Ther e was no trend toward the opinion that capitated payment arrangements are acceptable with greater levels of experience in capitated care (P = 0.5 by Spearman test). There were trends suggesting that compared wi th those who were not receiving capitated payments, those who received capitated payment were 50% more likely to have never discussed capita ted payment with any patient (63% versus 42%, P=0.08), were 70% more l ikely to very strongly oppose the use of capitation to pay their own f amily's physicians (49% versus 29%, P = 0.07), and were 30% more likel y to believe that it is impossible to stay in the practice of medicine without participating in capitated payment plans (84% versus 65%, P=0 .06). None of the respondents reported that they had a contractual ''g ag clause,'' but 34% (27 physicians) said they would not speak publicl y about any perceived risks of capitated payments anyway. Among this s ample of physicians, those who participated in existing capitated paym ent managed care plans had views that were as negative, or more negati ve, on the acceptability of capitated payment as did those of nonparti cipating physicians. Many were participating in capitated payment plan s in spite of these negative views because they feared that to do othe rwise would force them out of medical practice, The hypotheses generat ed by this study must be tested in larger, national studies.