US physicians put patients' best interests above concerns about health care costs

"Physicians feel stuck in a difficult position," says lead author Jon Tilburt, M.D., Mayo Clinic's Biomedical Ethics Program and Center for the Science of Health Care Delivery. "Despite their sense of responsibility to address health care costs, physicians consistently express a commitment to the best interests of patients even when it is expensive. Given this finding, we recommend that cost-containment strategies aimed at physician behavior should focus on innovations that not only promote savings but also preserve physicians' commitment to individual patients."

Survey highlights include:

* The vast majority (85 percent) agreed that "trying to contain costs is the responsibility of every physician."

* Most (76 percent) reported being aware of the costs of tests or treatments they recommend.

* Nearly 80 percent endorsed prioritizing patients' best interests over issues of cost.

* Most ascribed "major responsibility" for reducing health care costs to trial lawyers, health insurance companies, and pharmaceutical and device manufacturers. In contrast, most (59 percent) thought practicing physicians were only "somewhat responsible."

Researchers also assessed physicians' attitudes about strategies to constrain health care spending.

Major findings include:

* Most expressed enthusiasm for cost-containment initiatives aimed at improving the quality and efficiency of care, and favored improving conditions for making decisions based upon cumulative medical evidence. For example, 69 percent were very enthusiastic about promoting chronic disease care coordination, and 63 percent were very enthusiastic about limiting corporate influence on physician behavior.

* Physicians' opinions were mixed on making payment changes to control costs. For example, 65 percent were not enthusiastic about paying a network of practices a fixed, bundled payment for managing all care for a defined population, and 70 percent were not enthusiastic about eliminating fee-for-service payment models.

"We found that physicians' degree of enthusiasm for various cost-containment strategies was associated with practice setting and compensation structure," says Dr. Tilburt. "Salaried physicians and those in larger institutional practice settings reported a significantly higher degree of cost-consciousness compared to physicians whose compensation is based on billing and those in small or solo practices."

The study was funded by the Greenwall Foundation and the Mayo Clinic Program in Professionalism and Ethics. Co-authors include Matthew Wynia, M.D.; Robert Sheeler, M.D.; Bjorg Thorsteinsdottir, M.D.; Katherine M. James; Jason S. Egginton; Mark Liebow, M.D.; Samia Hurst, M.D.; Marion Danis, M.D.; and Susan Dorr Goold, M.D.