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Geographic Variation, Physician Practice Patterns and Malpractice Fears

By April 15, 2010Commentary

The apparent existence of significant differences in utilization of health services and per capita health spending has been the source of claims that rationalizing those differences could result in savings.  There has been debate over how much variation there really is; how much might be justified and what the causes of the variation that does exist are.  A recent study looked at differences in physician practice styles and attempted to ascertain what factors might account for those differences.  (Circulation Study)

Coronary artery disease accounts for a good amount of health utilization and spending and there is significant reported variation in its treatment.  The researchers therefore surveyed 600 cardiologists to determine the intensity of their practice style, using vignettes of common clinical situations and asking the cardiologists what kinds of tests and procedures they would likely perform.  The doctors were also asked about non-clinical factors which might affect their treatment decisions, including what they thought peers would do, patient expectations, referring physician expectations, fears about malpractice suits and increasing their income.

The authors concluded that regional variation in utilization and spending has some relationship to practice style, with higher spending regions being associated with more intensive practice styles.  The relationship was stronger in regard to overall spending than cardiac care specific spending.  The cardiologists did not report being influenced by income-generation and the non-clinical factors which appeared to have the greatest relationship to utilization and spending were practice patterns of peers and malpractice concerns, particularly the latter.  While the study is based on surveys, it likely has some methodological rigor.  Just another piece of data that suggests that if policymakers really wanted to address the costs caused by unnecessary care, they should reduce malpractice exposure.

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