Responder—The Outlook for Pediatrician Incomes Under Managed Care

[摘要] Dr Hirsch analyzed a number of issues related to the economic viability of pediatric practice. I have chosen to explore one issue for my response: the outlook for pediatrician incomes under managed care. Dr Hirsch offers a disconcerting scenario. First, the demand for pediatricians is at risk, because managed care plans may want to substitute family physicians (one-stop shopping appeal) and pediatric nurse practitioners (perceived less costly substitutes) for primary care pediatricians. Second, price and premium cutting by managed care plans to maintain their market share eventually must result in lower compensation for all providers. Even now, there is evidence of price cutting for large employers in areas with high managed care penetration (Winslow R. Employer costs slip as workers shift to HMOs. Wall Street Journal . February 14, 1995, page A3). Logically, price cutting should proliferate to smaller purchasers and to all geographic regions. The conclusion is that pediatrician incomes, or at least their per-service compensation, is likely to decline as managed care becomes the norm.This compelling theory has some supporting evidence, but I am considerably more upbeat. Although the restructuring of office practice as described by Dr Hirsch may be painful, I contend that the specialty, because it has already accomplished much of this reengineering, is preparing well for its inevitable total transformation. My optimism is based on an examination of the recent past. In 1994, more than 50 million Americans were enrolled in health maintenance organizations (HMOs),1 and an estimated 100 million were enrolled in managed care of some form.2

[学科分类] 儿科学