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.