By Diane Duke Williams
March 23, 2001
Cost-containment bonuses for physicians trouble patients. So health plans and physicians should address patients' concerns by initiating a dialogue with them, said Thomas H. Gallagher, M.D., in the March/April issue of Health Affairs.
"Health plans and doctors need to take patients' concerns more seriously," said Gallagher, assistant professor of medicine and primary author of the paper. "And we need to figure out how doctors and patients can work together and have conversations about these incentives."
Managed-care plans are providing physicians with new types of financial incentives to encourage more cost-conscious medical care, such as giving bonuses to doctors who have not referred too many patients for specialty care or other services.
To determine patients' attitudes toward these bonuses, Gallagher and researchers at the University of California, San Francisco, and the Kansas Health Institute in Topeka conducted 1,050 random telephone interviews in areas where managed care is common. The researchers asked each participant about a bonus in which physicians could earn up to 10 percent extra income for controlling health-care costs. They also asked each participant whether physician bonuses should be disclosed.
Seventy-three percent of the respondents said a 10 percent cost-control bonus was a bad idea, and 66 percent thought a cost-control bonus would decrease their trust in their doctor. Eighty-five percent said they would choose a health plan that had no bonuses over a plan that used cost-control bonuses.
Ninety-one percent of the respondents favored disclosure of their physicians' bonuses. However, 82 percent said they should be told about bonuses without having to ask, and 38 percent believed that asking their doctors about bonuses could make their doctors angry with them.
"We discovered that patients find bonuses worrisome and favor their disclosure," Gallagher said.
He believes that, in the future, health plans and physician groups should move beyond mere disclosure of financial incentives and start talking with patients about the broader issue of cost-effective medicine. For example, patients might be less critical of incentives once they understand the rising costs of medical care, the evidence that many tests and procedures doctors order may be unnecessary and the difficulty of changing physicians' behavior without using financial incentives. He suggests these groups establish consumer boards or use focus groups to begin such a dialogue with patients.
"Talking to patients will show that their fears about managed care are being taken seriously," he said."This dialogue also might help develop innovative cost-controls that generate less patient concern about conflicts of interest."
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