WHAT FACTORS INFLUENCE PRIMARY-CARE PHYSICIANS CHARGES FOR THEIR SERVICES - AN EXPLORATORY-STUDY USING STANDARDIZED PATIENTS

Objective: To determine the extent of variation in physicians' charges for health care encounters with unannounced standardized patients and factors associated with the variation. Design: Cross-sectional study. Setting: Family practices open to new patients within 1 hour's drive of Hamilton, Ont. Participants: A stratified random sample of 125 phys icians who had responded to an earlier survey regarding preventive car e were invited to participate. Of the 125, 44 (35.2%) declined to part icipate, and an additional 19 (15.2%) initially consented but later wi thdrew because they closed their practices to new patients. Sixty-two physicians thus participated in the study. Intervention: Unannounced s tandardized patients posing as new patients to the practice visited st udy physicians' practices between September 1994 and August 1995, port raying 4 scenarios: 28-year-old woman, 52-year-old woman, 48-year-old man and 70-year-old man. Outcome measures: Physician characteristics, encounter characteristics and charges made for services. Results: The 62 physicians had 246 encounters with the standardized patients. Charg es were made to the health insurance plan for services by 59 physician s for up to 4 encounters (215 encounters in all). Charges varied consi derably both within and across patient scenarios. Time spent with the patient was an important factor predicting charges made (p < 0.01), al though the effect oi time spent on charges varied across scenarios (p < 0.01). Fee-for-service physicians charged more for their services th an physicians who usually had alternative billing arrangements (p < 0. 01). Female physicians charged more for their services than their male colleagues (p = 0.03). No relation was found between quality of preve ntive care and charges made (p = 0.15). Conclusions: Physician-related factors are better able to account for the variability in charges for their services than patient-related factors. Physicians seeing compar able patients may earn much more or less than their colleagues because of differences in the services they provide and the way they apply th e fee schedule. Quality-assurance techniques are likely needed to redu ce the variability in charges seen and increase value for money spent in health care.