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The Journal of Bone and Joint Surgery 79:1892 (1997)
© 1997 The Journal of Bone and Joint Surgery, Inc.

Correspondence

Correspondence

Ron Clark, M.D., Scott Gottlieb, B.A. and Thomas A. Einhorn, M.D.

TO THE EDITOR:

My compliments to Gottlieb and Einhorn for their excellent article "Current Concepts Review. Managed Care: Form, Function, and Evolution" (79-A: 125–136, Jan. 1997) and to the Editor for its publication. One area that was not discussed was the mechanism that enables health-maintenance organizations (HMOs) and preferred-provider organizations (PPOs) to exact continued fee reductions from orthopaedic surgeons and other physician providers. A major change resulting from a switch from indemnity insurance to managed care is that patients no longer purchase physician services directly from the physician. The actual purchaser has become the HMO or PPO, and the patient has passed the physician-selection authority to the managed-care plan. Now a limited number of managed-care plans select from hundreds of physician providers in a given market area (fewer buyers than sellers), a distinctly different situation than when thousands of patient purchasers selected from hundreds of physicians (more buyers than sellers). . . . [Full Text of this Article]


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