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et al., supra note 125, at 292-93 (discussing vicarious liability as applied to physician-hospital relationship as "independent contractor theory"). As the courts have considered the range of situations in which physicians provide care in the hospital setting,they have extended agency principles to limit the independent contractor defense. See id. In the last four decades, the courts have grappled with the independent doctor's connection to health care institutions, using a number of doctrines to circumvent vicarious liability limitations. See generally Arthur F. Southwick, The Law of Hospital and Health Care Administration (2d ed. 1988) (discussing various doctrines used by courts to avoid limitations on vicarious liability in context of physician-hospital relationship).129129 See Edward Felsenthal, Medical Plans Are Shouldering More Liability for Doctors' Errors, Wall St. J., Oct. 18, 1993, at B8 (noting transformation in health care system as to responsibility for delivery of care).130130 See David Frankford, Managing Medical Clinician's Work Through the Use of Financial Incentives, 29 Wake Forest L. Rev. 71, 84 (1994)(criticizing management of physicians using incentive-based plans). Frankford argued that "[health care] plans resting upon financial incentives to manage professional work conflict with the values professionals espouse." Id.
Page 18 of 32SYMPOSIUM: PURSUING HEALTH IN AN ERA OF CHANGE: EMERGING LEGAL ISSUES IN MANAGEDCARE: ARTICLE: REGULATING THE MANAGED CARE REVOLUTION: PRIVATE ACCREDITATION AN....MCOs contend that they can provide less expensive care, while maintaining the overall quality of care. 131Somegroups fear this evolution within the health care system. They worry that MCOs will limit physician options. 132Theyworry that MCOs will harm patients through systematic cost-cutting. 133They foresee "cookbook medicine" throughim- [*387] posed practice guidelines, 134bureaucratic controls through utilization review 135and dissipation ofphysician-patient trust as a result. 136They fear that profound inequality within our health care system will resultfrom any rush towards efficiency-based medicine. 137Primarily, however, they fear a corporatization of health care.138They fear that under such corporatization, doctors will come to resemble little more than production workers in amedical version of the assembly line, with corporate management tools and statistical process analysismicromanaging physician work.An effective managed care system rests on three principles. First, physicians have primary responsibility for bothcost control and quality improvement. Physicians act as a spigot in the health care system, controlling enormous131131 See James P. Murray et al., Ambulatory Testing for Capitation and Fee-for-Service Patients in the Same Practice Setting:Relationship to Outcomes, 30 Med. Care 252, 252 (1992) (finding that "[hypertensive] patients with capitation health insurance had fewer laboratory tests and lower overall charges than the fee-for-service patients, with no clinical or statistically significant differences in 1-year health outcomes"); Barbara Starfield et al., Costs vs. Quality in Different Types of Primary Care Settings,