The impact of physician financial incentives on high-risk populations in managed care

Article Abstract:

Managed care plans must balance financial incentives to medical providers with quality assurance programs to ensure that all patients receive appropriate care. Financial incentives are designed to reward efficient medical care and to controls costs. This mechanism may encourage managed care physicians to undertreat their patients. The small proportion of people who use the most medical services may have the highest risk for undertreatment. Premier quality assurance programs incorporate physician participation, peer review, clinical standards, and assess members' satisfaction and uphold members' rights. Optimal programs strike a balance between the risks and rewards of treatment to promote cost-effectiveness without sacrificing appropriate medical care. Financial incentives should be linked to quality assurance measures, risk adjusted, and applied to medical specialists.

Quality management, Incentives (Business)

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HIV care: a capitated alternative

Article Abstract:

Insurers, HIV-infected people, and medical providers may benefit from a cluster of excellence model of HIV care. Under this managed care-based system, insurers direct HIV-infected patients to a health care site where they are treated by a network of HIV specialists. A coordinated continuum of care meets the needs of HIV patients in varying stages of the disease. Physicians receive a pre-paid monthly monetary sum per patient to cover all treatment costs. The provider has full control over medical decisions and assumes the financial risk that once belonged to the insurers. Physicians can intervene aggressively when the disease is in its early stages to limit future hospitalizations and control costs. The cluster of excellence model may control geographic variability in treatment costs and hospitalization patterns for HIV-infected people.

Models, Capitated payment systems (Medical care)

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Failure of high-dose oral acyclovir to suppress CMV viruria or induce ganciclovir-resistant CMV in HIV antibody positive patients

Article Abstract:

The drug acyclovir may not prevent or suppress cytomegalovirus infection in symptomatic HIV-positive patients. Researchers divided 93 HIV-positive patients into two treatment groups. The first group received 600 milligrams of zidovudine (ZDV) each day and 4,800 mg of acyclovir per day, while the second group took 600 mg of ZDV per day and a placebo. Patients in the acyclovir group excreted cytomegalovirus (CMV) in their urine, indicating that acyclovir did not prevent reactivation of CMV in these patients. These patients had CD4 cell counts exceeding 200. Treatment with acyclovir for over a year did not cause CMV to become resistant to the drug ganciclovir.

Evaluation, Drug therapy, Cytomegalovirus infections, Acyclovir

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