Most of the managed healthcare plans base the patient outcomes on a number of factors, and the doctors report is either not a factor at all or a small factor. I

Most of the managed healthcare plans base the patient outcomes on a number of factors, and the doctors report is either not a factor at all or a small factor. If the patients are being readmitted multiple times that will outweigh what is misreported. But more generally I agree that there will always be financial pressure weighing against ethical issues or patient outcomes. But a managed care plan is strictly better than fee for service in aligning patient outcomes and incentives for healthcare providers. And there is market pressure going the other way, patients can switch healthcare plans or switch providers if they have a better alternative with better outcomes.