Physician Deselection: The Dynamics of a New Threat to the Physician-Patient Relationship

1997 ◽  
Vol 23 (4) ◽  
pp. 511-537
Author(s):  
Richard S. Liner
Keyword(s):  
Primary Care ◽  
Managed Care ◽  
Care Physician ◽  
Fee For Service ◽  
Patient Relationship ◽  
Physician Patient Relationship ◽  
Green Is ◽  
One Year ◽  
Physician Patient ◽  
Managed Care Organizations

Dr. Julia Green is a primary care physician (PCP) licensed to practice medicine in the Commonwealth of Massachusetts. On October 1, 1994, Dr. Green signed a one-year, renewable contract with Allcare Health Plan (AHP). Pursuant to the terms of the contract, on January 1, 1995, AHP placed her on its select list of PCPs available to its 100,000 covered lives (“enrollees”). Dr. Green provided for all primary care and specialist referrals for those enrollees who chose her as their physician. AHP paid her on a fee-for-service (FFS) basis for all preapproved procedures and treatments.Dr. Green felt that this contract might decrease her autonomy slightly; however, she also felt that it would increase her patient pool significantly and lessen the burden of collecting fees directly from patients. Dr. Green knew that choosing not to sign the contract would preclude AHP enrollees from making her their PCP because AHP only covered treatment provided by its own physicians. She further feared that as enrollment in managed care organizations (MCOs) increases, and more of her colleagues sign managed care contracts, her pool of potential patients would decrease drastically.

Conflicts of Interest and Management in Managed Care

2000 ◽  
Vol 9 (2) ◽  
pp. 189-204 ◽  
Author(s):  
GEORGE J. AGICH ◽  
HEIDI FORSTER
Keyword(s):  
Managed Care ◽  
Conflicts Of Interest ◽  
Economic Incentives ◽  
Patient Relationship ◽  
New Paradigm ◽  
Physician Patient Relationship ◽  
Physician Autonomy ◽  
Practice Of Medicine ◽  
Physician Patient ◽  
Significant Attention

The bioethics literature on managed care has devoted significant attention to a broad range of conflicts that managed care is perceived to have introduced into the practice of medicine. In the first part of this paper we discuss three kinds of conflict of interest: conflicts of economic incentives, conflicts with patient and physician autonomy, and conflicts with the fiduciary character of the physician–patient relationship. We argue that the conflicts are either not as serious as they are often alleged to be or not unique to managed care. In part two we argue that managed care represents a new paradigm for medical care that features a new concept of management. We discuss three types or levels of management that managed care highlights, namely, administrative, clinical, and resource, which together offer a more sophisticated vantage point from which to assess patient care. We do not endorse managed care, but attempt to highlight some of the positive changes brought by managed care that were difficult to attain under traditional reimbursement systems.

The Effects of Electronic Medical Record (EMR) Use in Primary Care on the Physician-Patient Relationship

2013 ◽  
pp. 130-150
Author(s):  
Shira Assis-Hassid ◽  
Iris Reychav ◽  
Joseph S. Pliskin ◽  
Tsipi Heart Heart
Keyword(s):  
Primary Care ◽  
Healthcare Quality ◽  
Healthcare Services ◽  
Patient Communication ◽  
Patient Relationship ◽  
Healthcare Outcomes ◽  
Physician Patient Relationship ◽  
Theoretical Frameworks ◽  
Physician Patient Communication ◽  
Physician Patient

The implications of the physician-patient relationship and communication on healthcare quality have been widely discussed in previous research. Communication has been characterized as one of the most powerful, encompassing, and versatile instruments available to the physician, and it has been suggested that good physician-patient communication can improve healthcare outcomes. The incorporation of ICT in healthcare and, more specifically, the introduction of EMRs in primary care provide an opportunity for improving healthcare services and quality of care. Healthcare ICT has without a doubt transformed the dynamics of the medical encounter. Implications of EMRs on the physician-patient communication, and thus on healthcare quality have not yet reached a full understanding. The authors suggest a research model based on theoretical frameworks derived from the IS and medicine disciplines, describing factors affecting appropriate use of EMR, which will lead to physician and patient satisfaction.

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