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Arch Intern Med. 2002;162:716-718.

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

Physicians practice in a climate of cost containment mandated by both private insurance carriers and the federal government. Large employer groups, wielding vast numbers of employee patients, exert considerable influence in the health care market. These companies seek to limit their out-of-pocket expense and yet provide their employees with the maximum amount of health coverage for the dollar. This stimulates intense competition to provide the best medical care at the least cost. Unfortunately, this tends to adversely affect physicians and hospitals. Private insurance carriers attempt to control health care costs in today's medical practice through managed care, restricted formularies, preauthorization for outpatient services, and limited reimbursement. Managed care plans use capitated payments as a mechanism to control rising health care costs with varying degrees of success—and failure. The federal government (through Medicare in the outpatient setting) controls costs in similar ways by limiting covered services, mandating reduced fees for health . . . [Full Text of this Article]

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