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Physician Rationing of Care

By July 26, 2016Commentary

Doctors, with their power to prescribe and order treatments, are often cited as the primary gatekeeper for overall health care spending.  A study published in the Journal of General Internal Medicine surveyed around 2500 physicians to ascertain their self-reported rationing of health care.   (JGIM Article)   In regard to ten interventions, such as MRI, lab tests, specialist referrals, surgery referrals, and hospital admissions, doctors were asked if they didn’t order the intervention due to cost concerns, even if they thought the intervention might be in the best interest of the system.  53% of physicians reported that they had refrained from using at least one of the interventions in the prior 6 months for cost reasons, with drugs and MRI being the two areas mentioned most frequently.  Most of the doctors, however, said that such cost rationing occurred very infrequently.  The age, sex, geographic area and compensation type of the doctor were not associated with rationing behavior.  Surgical and procedural specialists were less likely to report rationing behavior than were primary care physicians.  Physicians in small or solo practices also said they engaged in rationing for cost reasons more than doctors employed by group practices or health plans.  And rather obviously, doctors who thought rationing was permissible were more likely to engage in that behavior.

We are placing physicians in an impossible position, which adds to the stress they already feel.  Their real job is to help their patients be in as good a health status as they can be.  We now incent or punish them for delivering or not delivering care in a certain way, even though the “guidelines” for such care are often not well supported by research.  They are beginning to be punished for their use of resources in delivering care.  None of this is consistent with a physician being able to focus on what they truly think is best for the patient.  Physicians are economic beings, as we all are, but I am not sure it is better to have bureaucrats deciding what good care is on a “population” basis.  I think each of us would prefer that our physicians treat us as individuals and while they should engage us in good decision-making about what treatments or tests actually are appropriate, we shouldn’t want them to on their own decide we shouldn’t get a treatment because of concerns about national health spending.

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