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Gil L. Solomon, MD
West Hills, Calif

JAMA. 1997;278(12):977.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.

—While I am reluctant to find fault with Dr Lynn's article¹ elucidating the issues involved with dying patients and offering concrete suggestions for managing them, I am disturbed by the implication that achieving excellence in the care of the dying patient will have an adverse financial effect under capitation. While this is a possibility, there are no data offered to support this statement.

The patients in health maintenance organizations who switch medical groups will probably need to leave their specialists along with their primary care physician. I believe that ill patients would want to stay with physicians who know them rather than move to a new group (even if it does have a reputation for excellence). Also, there is no reason to assume that awareness of an organization's exceptional reputation would not attract a higher proportion of healthy patients than ill patients. I believe sicker patients . . . [Full Text PDF of this Article]

Footnotes
Edited by Margaret A. Winker, MD, Senior Editor, and Phil B. Fontanarosa, MD, Senior Editor.

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