We have all heard the horror stories that result when people with business backgrounds make decisions about health care. And, unfortunately, business types are calling the shots for many of the HMOs and insurance companies, and we often end up suffering as a result. However, there is a movement towards physician groups interacting directly with employer groups and providing health care without an insurance or HMO intermediary. Physicians and the media claim that things will be better as physicians are far better prepared than business types to make proper medical decisions about their patients.

Is this claim correct? It is true that physicians have the knowledge and training to make more informed decisions about medical care than someone with a Master of Business Administration degree. But do physicians follow through based on their knowledge? The answer is a resounding no according to an article in the July, 1997 issue of the Public Citizen Health Newsletter by Dr. Brant Mittler, an internist practicing in San Antonio, Texas.

Dr. Mittler reports on an article from the December 21, 1995 New England Journal of Medicine that analyzed data from 700,000 patients at six large California capitated medical groups. For all six of these physician-run groups, the number of hospital days per 1,000 enrollees was "substantially lower than California or national averages." In addition, the rates of MD visits per enrollee in 1994 were lower than for all California and national HMOs.

Dr. Mittler considered the possibility that these numbers reflected more efficient care. In his consideration, he used data from a UCLA and RAND study that appeared in the October, 1996 issue of the Journal of the American Medical Association. He quoted the authors of the study who concluded that capitated physician groups may be limited in doing adequate quality assurance by financial considerations. In other words, systems set up to ration care are going to do so whether run by doctors or MBAs. Based on the California data, Dr. Mittler stated "that doctors given control of capitated dollars ration care with a vengeance."

Although everyone expects businessmen to try to maximize profits without going to jail, it is disappointing to see that physicians go to even greater extremes in rationing health care to their patients.