The Pitfalls of Managed Care

Your editorial of Feb. 25 on the OPTIMA managed care program contains a paragraph which goes to the heart of the underlying flaw of so-called managed care plans.

As you rightly point out, doctors in such plans are paid a flat fee per patient per month to care for the patient. Notwithstanding the fact that the amount paid this way is ridiculously low--about $8 for OPTIMA--such a system essentially places the doctor at financial risk for the illness of the patient. In a flat payment, the patient who is ill becomes a financial liability to the doctor, who is then supposed to decide on the best medical care for the ill patient. Who do you think will suffer in this case?

The very patient who is in need of the health services will in time get shortchanged by this process. The flat fee payment system, otherwise called capitation, has the potential to pervert the relationship between the ill patient and his or her physician. It places a relentless, undue burden on the physician, who has to find the right line between ethical calling and financial survival whenever he or she sees a patient. Would you feel secure being cared for in such a system?

ED MOORE

Irvine