The managed care revolution has significantly changed the delivery and finance of healthcare in the United States. Previously, under the fee for- service regime, the alignment of incentives in the healthcare system encouraged the provision of care for patients: Patients could self-refer to primary care physicians or specialists without penalty; physicians were content to provide needed care (and more) in accordance with their professional ethic; and, because payers simply paid the bills, physicians had no financial incentive to leave any stone unturned in diagnosing and treating patients. Thus, physicians, as the primary decisionmakers, were arguably the appropriate parties to be held liable for patient injury.
Liang, Bryan A.
"Patient Injury Incentives in Law,"
Yale Law & Policy Review: Vol. 17
, Article 2.
Available at: http://digitalcommons.law.yale.edu/ylpr/vol17/iss1/2