Hired Help: A Physician's Experiences in a for-Profit Staff-Model HMO
New England Journal of Medicine. 1988 Sep 22; 319(12): 787-790.
A physician describes some of the problems and conflicts that emerged during his two-year experience in a health maintenance organization (HMO) as both primary care provider and subspecialist. These problems included difficulties with arranging outside consultations, admission of patients to nonparticipating hospitals, hospital rounds and relationships with colleagues, call duties, lack of control over office hiring and procedures, subspecialty practice within the HMO, and the conflict between functioning as patient advocate and insurance representative. The author, who left the HMO disillusioned, concludes that the intense involvement of the primary care provider in administrative activities detracts from patient care and serves primarily the interests of the HMO in tracking, predicting, and controlling expenditures. (KIE abstract)
Conflict of Interest; Consultation; Decision Making; Economics; Employment; Health; Health Care; Health Care Delivery; Health Maintenance Organizations; Hospitals; Incentives; Institutional Policies; Insurance; Organizations; Patient Admission; Patient Advocacy; Patient Care; Patients; Physicians; Referral and Consultation;
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