OBJECTIVE: There is increasing public discussion of the value of disclosing
how physicians are paid. However, little is known about patients' awarenes
s of and interest in physician payment information or its potential impact
on patients' evaluation of their care.
DESIGN: Cross-sectional survey.
SETTING: Managed care and indemnity plans of a large, national health insur
er.
PARTICIPANTS: Telephone interviews were conducted with 2,086 adult patients
in Atlanta, Ga.; Baltimore, Md/ Washington DC: and Orlando, Fla (response
rate, 54%).
MEASUREMENTS ANI) MAIN RESULTS: Patients were interviewed to assess percept
ions of their physicians' payment method, preference for disclosure, and pe
rceived effect of different financial incentives on quality of care. Non-ma
naged fee-for-service patients (44%) were more likely to correctly identify
how their physicians were paid than those with salaried (32%) or capitated
(16%) physicians. Just over half (54%) wanted to be informed about their p
hysicians' payment method. Patients of capitated and salaried physicians we
re as likely to want disclosure as patients of fee-for-service physicians.
College graduates were more likely to prefer disclosure than other patients
. Many patients (76%) thought a bonus paid for ordering fewer than the aver
age number of tests would adversely affect the quality of their care. About
half of the patients (53%) thought a particular type of withhold would adv
ersely affect the quality of their care. White patients, college graduates,
and those who had higher incomes were more likely to think that these type
s of bonuses and withholds would have a negative impact on their care. Amon
g patients who believed that these types of bonuses adversely affected care
, those with non-managed fee-for-service insurance and college graduates we
re more willing to pay a higher deductible or co-payment in order to get te
sts that they thought were necessary.
CONCLUSIONS: Most patients were unaware of how their physicians are paid, a
nd only about half wanted to know. Most believed that bonuses or withholds
designed to reduce the use of services would adversely affect the quality o
f their care. Lack of knowledge combined with strong attitudes about. vario
us financial incentives suggest that improved patient education could clari
fy patient understanding of the nature and rationale for different types of
incentives. More public discussion of this important topic is warranted.