Physician incentives and disclosure of payment methods to patients

Citation
Ac. Kao et al., Physician incentives and disclosure of payment methods to patients, J GEN INT M, 16(3), 2001, pp. 181-188
Citations number
38
Categorie Soggetti
General & Internal Medicine
Journal title
JOURNAL OF GENERAL INTERNAL MEDICINE
ISSN journal
08848734 → ACNP
Volume
16
Issue
3
Year of publication
2001
Pages
181 - 188
Database
ISI
SICI code
0884-8734(200103)16:3<181:PIADOP>2.0.ZU;2-V
Abstract
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.