I READ your front-page article regarding the proposed return to a capitated health plan reimbursement system ("State seeks to revamp way doctors, hospitals are paid," Page A1, May 7). I practiced under that system in the late 1980s and early ’90s.
The central flaw in the plan is that it does not address liability reform. Indeed, the article doesn’t even mention defensive medicine as a component in the equation.
No system can succeed if it fails to fix the medical liability situation for individual physicians. Much of the medical spending labeled "unneeded" or "of questionable benefit" is defensive in origin, and can and, I assure you, will continue under any system that continues to punish providers for a bad outcome even if they follow accepted standards of evaluation and management.
At present, I and most physicians I know evaluate a patient with two mental lists: most likely diagnosis and most reasonable course of evaluation, and worst-case diagnosis, with evaluation designed accordingly. If you look at medical spending, you realize that we often act on the latter scenario. Talking about other components of controlling healthcare spending is important, but if you ignore liability reform from the outset, you are starting a medical Big Dig with a tube of epoxy in your hand.
Dr. Gregory D. Opritza
Bedford, N.H.
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