Center for Studying Health System Change

44% of Patients Think Insurers Influence Medical Care Decision While Trust in Doctors Remains High

News Releases
June 28, 2000

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ASHINGTON, DC – Americans overwhelmingly trust their doctors to put medical need before insurance rules when making care decisions according to a new study (Data Bulletin #17) released by the Center for Studying Health System Change (HSC). This finding comes despite a belief among many consumers that HMOs and other health insurers strongly influence physicians.

African-Americans, Hispanics, and the poor were found more likely to perceive a strong insurer influence on their doctor. In addition, a greater percentage of Hispanics believe that their physicians ultimately may not put their medical needs first.

"Society is faced with having to balance the cost savings of influencing doctors’ decisions about referrals, tests, and treatments against concerns that insurer interventions may threaten the quality of care," said study author and HSC researcher Lee Hargraves, Ph.D. "Even though the public is split on whether insurers have gone too far, patients express overwhelming confidence in their doctors."

The 1999 HSC survey found that 44 percent of adults with public or private insurance agreed with the statement, "I think my doctor is strongly influenced by health insurance company rules when making decisions about my medical care." At the same time, only 7 percent of consumers cited in the study felt that doctors fail to put patient’s needs first. The new findings show that public opinion on health insurer influence over physicians has remained stable since HSC first examined the issue in 1997, despite the consumer backlash against managed care.

"Health plans are dedicated to promoting the right care at the right time and in the right setting," said Karen Ignani, president of the American Association of Health Plans. "Our challenge is to streamline administrative procedures for physicians, encouraging best practice while reducing paperwork."

More than half of African-Americans and Hispanics (56 percent and 54 percent respectively) agreed that their doctors were influenced by insurance rules, as compared with 40 percent of whites. The HSC study also showed that Hispanics were more likely than both African-Americans and whites to believe that physicians may not put their medical needs first when making care decisions.

"The patient-physician relationship, which is crucial to our health care system, should not be undermined by health plans," said Ron Pollack, executive director of Families USA. "The enactment of the pending Patients’ Bill of Rights will undoubtedly serve to strengthen that trust."

Consumer views on insurance company influence over doctors also varied by the income level of those surveyed. As income increased, the study found a steady decline in the percent of those who believed that doctors are strongly influenced by the insurance industry, specifically, 50 percent of those below the poverty level believe doctors are heavily influenced versus 40 percent of consumers earning four times the poverty level.

"The challenge for policymakers on the Hill and in the White House is to reconcile consumer unease about insurer influence on the one hand, with their overwhelming confidence in their doctors on another and decide whether or not to intervene legislatively," said HSC president Paul B. Ginsburg, Ph.D.

The HSC study entitled, "Patients Concerned about Insurer Influences," examined results from the 1998-1999 Community Tracking Study (CTS) household survey, a nationally representative telephone survey that included about 32,000 families and 59,000 individuals. The survey follows up on the 1996-1997 CTS, which contacted a similar number of households. The analysis does not include people who lack health insurance.

The Center for Studying Health System Change – an independent research organization funded exclusively by The Robert Wood Johnson Foundation – provides objective, timely analyses about changes in the nation’s health care system and their impact on consumers to private and public decision makers. HSC, based in Washington, D.C., is affiliated with Mathematica Policy Research, Inc.