The ethics of managed care financial incentives to limit care. Some thoughts for specialists.

This article supplies an introduction to the structure and purpose of managed care financial incentives, with particular attention to those affecting referrals to specialists. It then addresses some of the ethical problems attending such incentive schemes and discusses the characteristics that make some financial incentives preferable to others. An agenda for specialists such as plastic surgeons who are often on the "receiving end" of incentive schemes designed to limit the use of specialty care is outlined. This proposed agenda encourages specialists to participate actively in shaping incentive schemes in ways that help keep health care costs down without sacrificing patients' interests in obtaining necessary specialty care.