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1st
appeared 6 April 1999
Physician Financial Incentives May Harm Quality
of Patient Care
A new study by a team of researchers at UCSF presents evidence that doctors may withhold
needed services from patients in response to financial incentives to control costs.
In a nationwide survey of internists, UCSF researchers also found that up to 50 percent of
physicians in managed care settings and 39 percent of physicians in fee-for-service
settings failed to prescribe services recommended by national guidelines. The more
restrictive the financial incentive, the less likely physicians would order recommended
tests or referrals. The study appears in the March issue of the Western Journal of
Medicine.
"This study shows that patient care may be compromised regardless of what financial
incentives are in place," said Steven Pantilat, lead author and assistant professor
of medicine at UCSF. "That can erode the public's trust."
Compared to fee-for-service plans, the restrictions of managed care resulted in a decrease
of 3 percent to 11 percent of physicians stating that they would order the appropriate
tests and referrals. Although the researchers' findings suggest that incentives in managed
care do lead physicians to withhold needed services, financial motives should not be
singled out as the only factor influencing doctors' decisions, said Pantilat.
Questionnaires were mailed to 1,030 general internists who belonged to the American
College of Physicians and practiced in metropolitan areas with populations of more than
250,000 where at least 30 percent of insured people belonged to managed care plans, said
Pantilat. In the survey, physicians were given four patient scenarios and asked to
determine whether they would prescribe the test or referral recommended by national
guidelines designed to identify or rule out life-threatening illnesses. The physicians
made their treatment decisions working under various fictitious combinations of financial
incentives and assessments of need.
In all cases, physicians working under the assumption of the most restrictive managed care
plan said they would order fewer services than physicians working under the assumption of
a fee-for-service plan.
"Because there has been concern in the medical community that financial incentives in
managed care will lead physicians to withhold necessary services, we wanted to see if
managed care members were getting sub-optimal care," said Pantilat. "We did see
a tendency toward offering fewer services to managed care patients, but we also found that
a significant number of all physicians did not follow nationally accepted guidelines for
care, regardless of the incentives."
Based on their results, the researchers believe the medical community needs better quality
control measures to ensure that physicians provide the recommended services.
"We need to establish a system that is more
responsive to the needs of the patient," said Margaret Chesney, UCSF professor of
medicine and co-author of the paper.
Source: Rebecca Sladek Nowlis, News
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