How the reimbursement system may influence physicians' decisions results from focus groups interviews in France

This paper analyzes how physicians' treatment choices are influenced by cos t to the patient for four different diseases in France: mild hypertension, hay fever, dyspepsia and hormone replacement therapy (HRT). Five focus grou ps of physicians were conducted in the fall of 1998. Thr paper reviews the type of shifts and strategies physicians used to reduce the cost to the pat ient. In order to maintain access to care for the patients, the most common strategy used is to refer to different types of social structures in the h ealth care system. However, a number of shifts related to drug or treatment choices were also identified such as prescription of older drugs, shifts t o drugs having different drug coverage and cheaper drugs within a drug clas s. In a proportional system of copayment, the price level of the services ( drugs or exams) clearly appeared as a determining factor to induce physicia ns' decision shifts. Overall, we also found that French physicians put high er priorities on the cost to society than on the cost to the patient in the ir treatment decisions. (C) 2000 Elsevier Science Ireland Ltd. All rights r eserved.