Physicians' ethical beliefs about cost-control arrangements.

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Abstract
THE MANAGED care revolution has transformed the methods by which physicians are paid, and it is subjecting their clinical decisions to unprecedented levels of supervision. Many primary care and specialist physicians now have financial incentives to reduce the number of tests, treatments, and referrals they order for their patients,1-3 and growing numbers of physicians are being encouraged to adhere to health plans' clinical practice guidelines.4,5 The world of fee-for-service reimbursement and informal, peer supervision is being supplanted by capitated payment,6,7 fee withholding, and bonuses tied to reduced clinical spending8; cost-conscious "gatekeeping" by primary care physicians9,10; and efforts by health care plans to discourage physicians from telling patients about expensive treatment options or their personal financial incentives.11,12