US Patients Don't Want to Know How Doctor Is Paid

By Suzanne Rostler

NEW YORK (Reuters Health) - The days when a doctor would perform an examination in exchange for a flat fee are on the wane in the US, replaced by a complex array of payment arrangements between doctors and their insurance or managed care companies.

But while these arrangements can influence the quality of healthcare a patient receives, only slightly more than half of adults--54%--wanted to know how their doctors are paid, results of a survey report.

Researchers from Harvard Medical School in Boston, Massachusetts, explain that the findings may reflect the trust patients place in their doctors. Or, patients who use doctors for routine procedures may not be concerned with the financial implications of payment arrangements, the study authors suggest.

Whatever the reason, patient demand for financial disclosure by their healthcare providers is likely to intensify, predict Dr. Audley C. Kao and colleagues.

"It also seems inevitable that patients increasingly will expect physicians to discuss issues of financial incentives, especially when such matters become relevant to care," the researchers write in the March issue of the Journal of General Internal Medicine.

Study author Dr. Paul Cleary told Reuters Health in an interview that consumers are concerned about the potential impact of health policies, but they know little about these policies. Making information about how doctors are reimbursed available to patients might help them understand payment issues.

"This might reduce some of their concern," Cleary said.

Under the traditional fee-for-service arrangement, doctors receive a predetermined amount from an insurance company for performing a menu of services. In recent years many doctors have become salaried employees under the managed care system, which is intended to cut medical costs by removing incentives to provide more--presumably unnecessary--services. A third payment method, capitation, gives doctors a fixed amount of money for each patient seen regardless of the type of care provided or the number of tests ordered.

In addition, many healthcare organizations also offer financial bonuses or withhold money to influence whether a doctor orders pricey tests.

According to the results, 53% of patients said their care would be adversely affected by a "withhold," in which the physician does not get money for ordering tests.

And 76% of adults surveyed believed that a bonus paid for ordering fewer tests would affect their medical care. Nearly two thirds of these patients (64%) said they would pay more to get medical tests they believed were important.

Survey findings are based on telephone interviews with nearly 3,000 adults in four US cities.

SOURCE: Journal of General Internal Medicine 2001;18:1-8.