Most physicians point to others to control healthcare costs

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1. US physicians feel that they are not the major players in controlling healthcare costs. 

2. A majority of US physicians were not supportive of strategies to control cost that would change payment structures or limit physician compensation. 

Evidence Rating Level: 2 (Good)            

Study Rundown: Physicians play a critical role in the distribution of healthcare. As a result, their outlook on the control of healthcare costs has become an important issue in the US healthcare system. A majority of physicians surveyed in this study favored various strategies that would help control medical costs.  These strategies include: promoting continuity of care, chronic disease care coordination, limiting corporate influence on physicians, and uncovering fraud. Most physicians, however, did not feel that they were chiefly responsible for controlling costs citing trial lawyers, health insurance companies, and pharmaceutical manufacturers as other parties to be held responsible. Finally, most physicians did not favor efforts to restructure the payment system that would decrease their reimbursement.  One drawback of the study is that most of the data found in the American Medical Association Masterfile (physician listing) contains self-reported specialty and practice structure information. Nonetheless, a major strength of this study is the diversity of the respondents in terms of demographic information (but not race and sex), compensation structure, practice setting, and political beliefs.

Click to read the study published today in JAMA

Click to read an accompanying editorial published today in JAMA

Relevant Reading: Health Care Reform and Cost Control

In-Depth [cross-sectional study]: This study surveyed 2,556 American physicians about controlling healthcare costs and issues relating to cost-consciousness.  Only 36% of physicians stated that they have a major responsibility in controlling cost. The majority of physicians felt that other parties, including trial lawyers and health insurance companies, carried more responsibility for limiting costs.  Most physicians expressed a great deal of support for cost reducing such as practicing evidence-based medicine.  However, the physicians surveyed were variably supportive of strategies that involved restructuring payment schemes.  While 79% of respondents supported adherence to clinical guidelines with regards to expensive tests, 78% stated that they felt obligated to individual patients regardless of cost.  Finally, physicians working in group settings were more cost-conscious than those working in small or solo practices (mean 0.87 units higher, 95% CI 0.29-1.45) and that physicians working for a salary plus bonus were more cost conscious (mean 0.82 units higher, 95% CI 0.32-1.33).

By Jeffrey Cohen and Brittany Hasty

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