In a “pioneering” effort to solve the reimbursement issue, a major Massachusetts health insurer proposes the following:

Blue Cross and Blue Shield of Massachusetts wants to stop paying doctors and hospitals for each patient visit or treatment, a common arrangement that most experts agree has led to unnecessary, inefficient, and fragmented care that is sometimes harmful to patients.

Instead, they want to pay doctors and hospitals a flat sum per patient each year, adjusted for age and sickness, plus a significant bonus if the providers improve care, Blue Cross officials said.

This is called capitation, and it was tried in the 1990’s. I think it works, and I would welcome the change. In general, primary care does financially better in a capitated environment versus a fee-for-service model.

Patients however, soundly rejected this form of reimbursement, saying it gave physicians a financial incentive to scale back testing – which generally is the point when it comes to controlling costs.

So, the onus is on the patient. How will they react when they are told “no”? Will capitation fail again in this second reincarnation? We’ll see.