25 February 2019 - In 1982, Starr predicted that relationships between physicians and organisations, including insurers, health systems, and hospitals, would challenge the medical profession’s autonomy, authority, and ability to self-regulate. 

In the intervening years, major growth and consolidation have occurred in nonprofit and investor-owned insurance entities, health systems, and physician practices. 

While tensions and challenges have coursed through all these relationships, among the most contentious have been relationships between those who provide care, such as physicians and hospitals, and those who pay for care, such as managed care organisations and Medicare.

Read JAMA Viewpoint