Risk aversion and costs - A comparison of family physicians and general internists

BACKGROUND The authors of previous studies have suggested that family physi cians generate lower health care expenditures than internists. Explanations for this difference have not been explored. METHODS We surveyed 61 family physicians and 112 internists within a manage d care organization regarding their demographic, practice. and psychologica l characteristics. We derived Physician costs per enrollee and case-mix adj ust ment using claims data. RESULTS In a multivariate analysis, we found that family physicians were si gnificantly less risk averse than general internists. After adjustment for case mix, family physicians generated 5% lower costs (95% confidence interv al [CI], 2% - 9%). After adjustment for case mix, risk-averse physicians ge nerated higher expenditures: a one standard deviation increase in risk-aver sion was associated with a 3% increase in expenditures (95% CI, 1% - 5%). A fter adjustment for case mix and risk aversion, family physicians' costs we re no longer significantly lower (3%: 95% CI, -1% to 7%). None of the other physician demographic, practice, or psychological characteristics were sig nificantly associated with case-mix-adjusted expenditures. CONCLUSIONS The lower costs per patient generated by family physicians comp ared with internists may reflect psychological differences in risk aversion .