Monday, July 29, 2013

US Physicians and Views on Controlling Healthcare Costs

I rarely write about health policy as it is not remotely in my area of expertise. 

Here is a report (free, full text)  published in JAMA this month. A cross-sectional survey was mailed in 2012 to 3897 US physicians randomly selected from the AMA Masterfile.

A total of 2556 physicians responded (response rate = 65%). Most believed that trial lawyers (60%), health insurance companies (59%), hospitals and health systems (56%), pharmaceutical and device manufacturers (56%), and patients (52%) have a “major responsibility” for reducing health care costs, whereas only 36% reported that practicing physicians have “major responsibility.” Most were “very enthusiastic” for “promoting continuity of care” (75%), “expanding access to quality and safety data” (51%), and “limiting access to expensive treatments with little net benefit” (51%) as a means of reducing health care costs. Few expressed enthusiasm for “eliminating fee-for-service payment models” (7%). Most physicians reported being “aware of the costs of the tests/treatments [they] recommend” (76%), agreed they should adhere to clinical guidelines that discourage the use of marginally beneficial care (79%), and agreed that they “should be solely devoted to individual patients’ best interests, even if that is expensive” (78%) and that “doctors need to take a more prominent role in limiting use of unnecessary tests” (89%). Most (85%) disagreed that they “should sometimes deny beneficial but costly services to certain patients because resources should go to other patients that need them more.” 

These results are telling. Many physicians favor cost containment strategies that enhance high quality healthcare. Predictably, many were against payment reform that impacts fee for service work. This last point will be a huge barrier in healthcare cost containment.

One factor at play is the tension between meeting the medical needs of the individual patient while being sensitive to the allocation of resources for the collective good of the population. This is a tension that we will need to better navigate. Another is that universal access to healthcare will erode some physician autonomy and earning potential. 

The resources are not infinite and doing things 'as always' will not fly in the face of more equitable access to healthcare.

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