Using a hypothetical case to measure differences in treatment aggressiveness among physicians in Canada, Germany and the United States

Variations in physician practice style, within and between countries, accou nt for much of the differences in the utilization of scarce health care res ources. Practice style differences are particularly important at the end of life, when a substantial amount of resources are consumed. We use a hypothetical case of a severely ill elderly patient to identify fa ctors associated with aggressive treatment and to test whether physicians i n the US practice differently from their counterparts in other countries. D ata come from a random sample of practicing physicians in three industriali zed countries, the United States, Canada and Germany (N = 1369). Although the case stated that the chance of survival of the patient was low , 73% of all physicians selected the aggressive treatment. Physicians from the United States were the most aggressive (86%), followed by Germany (68%) and Canada (61%). Practicing in the United States was the strongest predic tor of aggressiveness in the multiple linear logistic regression; German an d Canadian physicians were one fourth as likely to use aggressive treatment . Specialty training, older age and being a resident all increased the like lihood of selecting the more aggressive treatment. The fear of being sued f or malpractice and income did not have an effect on treatment decisions.