Patients will get good care from honest doctors under fee for service (FFS) or capitation systems. Dishonest doctors can profit at patient's expense by overutilization under FFS and by underutilization under capitation. At this point in the discussion one system is not clearly superior to the other. What makes the difference is the issue of information asymmetry. The doctor possesses far more information than most well informed patients. Under FFS, the patient has the opportunity to seek a second opinion if s/he thinks the proposed procedure may be unnecessary (except in emergencies). Recommendations are openly made for evaluation and questioning by the patient. Under capitation, the doctor may not even mention to the patient that a procedure should be considered. Thus the patient does not know that other options even exist and would be less likely to obtain a second opinion regarding the need for a procedure. Even if the doctor in a capitated system is honest and mentions all the options, how can the patient know for certain that some information isn't being withheld? As the patient has less means (information)at his disposal to evaluate the doctor's recommendations and knows that the doctor stands to profit financially from withholding information, an atmosphere of mistrust ensues regardless of the honesty of the doctor which is quite deleterious to the doctor-patient relationship. Some believe that measuring the quality of care will discourage doctors from withholding needed care. The ability to measure quality of care is in its infancy and I believe it will take a long time until it is advanced to the point where it will effectively discourage withholding needed care. Current quality of care measurements focus on limited, easily measurable things like vaccination rates. Aspects of medical care that are currently amenable to quality of care measurements represent only a tiny fraction of the totality of medical care. Increasing numbers of people are concerned about doctors receiving financial incentives to withhold care. Capitation is clearly a system that rewards doctors for withholding care.