Chuck Weller's commentary ("Decapitating healthcare," Aug. 31, p. 40) missed the point of capitation-the alignment of incentives away from a fee-for-service mentality to a structure whereby doctors (organized groups) and hospital systems (not individual hospitals) are held accountable for managing care. Unfortunately, many HMO chains transfer risk, which they are unable to manage, to provider groups through such approaches as current capitation and percentage-of-premium structures. Without the accompanying information (claims transaction data, etc.), and with fledgling physician and hospital managed-care infrastructures, the result is quite predictable.
Change has been incremental in this country's healthcare system. We put hospitals at full risk for inpatient episodes of care by introducing DRGs more than a decade ago. Scrapping payment structures isn't the way to go. Continuously seeking improvement on capitation via improved provider-sponsored structures and adequate information transfer to manage risk is the more prudent tactic.
President, chief executive officer
MedSpan, Hartford, Conn.