HMO Financial Incentives and Informed Consent

To the Editor.— The recent appearance of health maintenance organizations (HMOs) and other systems of managedcare provision has begun to stimulate concern over conflicts of interest between physicians and their patients. Ethical standards in this area will require further enhancement as political and economic pressures and constraints become more intrusive.¹

The ethical ideal would be best approached by removing all financial incentives from the medical decision process. It is difficult in practice to do this, since physicians and managers earn their livings making these decisions and must be compensated for their time. A method of financing that encourages neither too much nor too little care has yet to be invented.

The rapid growth of HMO enrollment over the past four years appears to be slowing as issues of quality and access begin to be raised. As HMOs are in a highly competitive environment now, pressures to enlist new health