Untangling regional variation in health spending is difficult, as shown by the multiple reports on the subject. And variation appears to occur almost at the patient or physician level, not necessarily at larger geographic areas. A paper published by the National Bureau of Economic Research focuses on the possible role of patient or physician preferences or beliefs about treatment. (NBER Paper) The authors used surveys of Medicare recipients and physicians who treat Medicare patients (remember that variation in Medicare and commercial spending can be different in the same locale) linked to data about utilization of services. The beneficiaries were asked about their preferences in regard to certain scenarios of aggressive versus palliative care. The physicians, separated into primary care doctors and cardiologists, were given four situations involving elderly patients and asked how they would treat the patients. Remembering that this is self-reported survey data, and self-reported data about beliefs, which can differ significantly from actual actions, the researchers found that patient preferences appeared to play an insignificant role in spending variation, although many patients expressed a preference for marginally necessary care, but that physician preferences appeared to be a major factor. In regard to these physician preferences, they did not appear strongly linked to malpractice concerns or other financial concerns, although we doubt many physicians would admit to providing more services to make more income, but they did appear somewhat correlated with meeting expectations of either patients or referring doctors. The strongest correlation, however, was with physician beliefs about the effectiveness of certain therapies, which can derive from either training or personal experience. Physicians showed significant variability in their beliefs about the efficacy of treatment options in the scenarios they were presented. Continued research on comparative effectiveness might be valuable in limiting treatment differences based on inaccurate beliefs about efficacy. The researchers estimate that as much as 36% of Medicare end-of-life spending and 18% of overall Medicare spending may be due to these physician beliefs that often are not consistent with the best evidence or care guidelines. Although there are significant limitations in the research methodology, it appears to provide a reasonable possible explanation for some of the variation in spending.
Physician Beliefs and Variation in Health Spending
By Kevin RocheNovember 7, 2013Commentary
✅ Subscribe via Email
About this Blog
The Healthy Skeptic is a website about the health care system, and is written by Kevin Roche, who has many years of experience working in the health industry. Mr. Roche is available to assist health care companies through consulting arrangements through Roche Consulting, LLC and may be reached at [email protected].
Healthy Skeptic Podcast
This is an outstanding report on total global drug spending and trends, with projections out to 2025. It helps you understand this important area of health care, which does much...
June 1, 2021
MedPAC 2019 Report to Congress
June 18, 2019
Another example of over-priced companies trying to find some way to survive in the post-epidemic financial world. Transcarent, which does something, somehow to “access high quality, affordable care” is buying...
March 6, 2023
In an attempt to swiftly revive two floundering health care companies, a PE firm has announced the merger and recapitalization of Revive Health and SwiftMD. You know they are...
January 30, 2023
Investors have not yet learned their lesson, as Pearl Health gathers a new round of $75 million in capital for its business of supporting physicians who want to participate in...
January 30, 2023
Access ACO Care Management Chronic Disease Comparative Effectiveness Consumer Directed Health Consumers Devices Disease Management Drugs EHRs Elder Care End-of-Life Care FDA Financings Genomics Government Health Care Costs Health Care Quality Health Care Reform Health Insurance Health Insurance Exchange HIT HomeCare Hospital Hospital Readmissions Legislation M&A Malpractice Meaningful Use Medicaid Medical Care Medicare Medicare Advantage Mobile Pay For Performance Pharmaceutical Physicians Providers Regulation Repealing Reform Telehealth Telemedicine Wellness and Prevention Workplace
March 25, 2023
Coronamonomania Lives Forever, Part 201
Tired of March Madness? A boringly refreshing dip into some CV-19 research summaries is recommended.
March 24, 2023
The CDC Is a Font of Methodological and Statistical Error
Several times in the last three years I and others have pointed out serious flaws…
March 24, 2023
A Couple of Health Care Notes
A couple of pieces of health care research focus on high health care spending and…