Patient, physician, and payer perceptions and misperceptions of willingness to pay for diagnostic certainty

Little is known about the value patients, physicians, and payers place on i ntangible attributes of care. Differences in valuations among these groups and misperceptions of value of intangible attributes to other groups can co ntribute to conflicts about treatment recommendations or coverage decisions . We surveyed patients, physicians, and managed care executives to assess t heir willingness to pay (WTP) for diagnostic certainty for peptic ulcer dis ease (PUD) and gastroesophageal reflux disease (GERD). To determine if pati ents, physicians, and payers accurately perceive each other's valuations of diagnostic certainty, participants were also asked to estimate the WTP of each of the other types of respondents. Patients were most likely, and exec utives least likely, to value diagnostic certainty. For PUD, 84% of patient s, 61% of physicians, and 43% of executives expressed a positive WTP. Media n WTP was low for all three groups ($1-9 for patients and physicians; $0 fo r payers). Physicians and executives both correctly predicted patient WTP. For GERD, 87% of patients, 52% of physicians, and 29% of executives express ed a positive WTP. Executives underestimated patient WTP. For both diseases , physicians' WTP was overestimated by patients and underestimated by execu tives. The inconsistency in the value that patients, physicians, and manage d care executives place on diagnostic certainty indicates the potential for conflict over practice guidelines or access to services. WTP surveys can p rovide information to aid in anticipating and addressing areas of disagreem ent.