April 9, 2007
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While almost 80 percent of physicians consider patient costs when prescribing a generic over a brand-name drug, far fewer consider patient costs when deciding what diagnostic tests to recommend (51.2%) or deciding whether to hospitalize a patient when outpatient treatment is an option (40.2%), the study found.
"Most physicians reported routinely considering insured patients out-of-pocket costs in clinically straightforward prescribing decisions, but only half or fewer do so in more complex situations that allow greater clinical discretion," said Hoangmai H. Pham, M.D., M.P.H., the studys lead author and a senior health researcher at HSC, a nonpartisan policy research organization funded principally by the Robert Wood Johnson Foundation, which solely supported the study.
"Because physicians consider patient costs less frequently in making decisions about more expensive services, its likely that increased patient cost sharing will be limited as an effective cost-control tool," said Pham, who coauthored the article with G. Caleb Alexander, M.D., M.S., of the University of Chicago Hospitals; and Ann OMalley, M.D., M.P.H., an HSC senior researcher.
The study, "Physician Consideration of Patients Out-of-Pocket Costs in Making Common Clinical Decisions" is based on HSCs 2004-05 nationally representative Community Tracking Study Physician Survey, which collected information from 6,628 practicing physicians. The survey response rate was 53 percent.
Noting that previous research has shown physician decisions affect how 90 percent of every health care dollar is spent, the authors point out that "whether increased cost sharing can effectively control health care spending depends on whether patients and physicians can together consider costs during clinical decision making."
During the survey, physicians were asked: How often do you consider an insured patients out-of-pocket costs for copayments and deductibles" in (1) "prescribing a generic over a brand-name drug if a generic option is available?" (2) "deciding the types of tests to recommend if there is uncertainty about a diagnosis?" and (3) "choosing between inpatient and outpatient care settings when there is a choice?"
Each of the clinical decisions studied entail different levels of physician discretion. Generic drugs typically are equivalent to brand drugs, while different diagnostic tests or care settings may involve significant trade-offs in safety or convenience. "For example, a physician trying to determine if a patients chest pain is cardiac in nature may order a simple treadmill stress test; a stress test with an echocardiogram to visualize pump function; or a higher risk but more definitive cardiac catheterization. Similarly, a patient with community-acquired pneumonia may be appropriately treated as an outpatient or admitted to a hospital, depending on the presence of comorbidities, severity of the infection, and presence of family or other support in the home," the article states.
Other key study findings include:
The Center for Studying Health System Change is a nonpartisan policy research organization committed to providing objective and timely research on the nations changing health system to help inform policy makers and contribute to better health care policy. HSC, based in Washington, D.C., is funded principally by the Robert Wood Johnson Foundation and is affiliated with Mathematica Policy Research, Inc.