How do current reimbursement mechanisms threaten the access of care to people with insurance?
Physicians pay is increasingly tied to denial of treatment and care. Many are offered bonuses based on how little they offer patients. Under capitation, in which the doctor receives a fixed monthly payment for each patient, the doctor’s economic interest is directly pitted against his or her patients. According to a report in the New England Journal of Medicine, in some high-risk capitation arrangements a physician’s income could vary between nothing and $150,000 per year depending on how many services that doctor provides, or more precisely, how many are denied. In other words, we have replaced the excesses of fee-for service medicine with those of fee-for-non-service medicine. Because a physician who has too many sick patients can literally go bankrupt, more and more physicians are explicitly rewarded for avoiding the sick and are equally explicitly advised to shun them. In July of 1996, for example, University of California Irvine Medical Center chief Philip Di Saia, M.D. sent a mem
