Broader disclosure also might make patients scrutinize their doctors' recommendations. "If you come to me with a hurt knee and I don't order an MRI," Gallagher says, "you might be more likely to obtain a second opinion if you knew I was getting a bonus for not making referrals."

Perhaps the most important impact of broader disclosure might be that it could act as a deterrent. "Plans might be more cautious in the type of incentives they adopt if they feel as if those incentives would be disclosed publicly," Gallagher suggests.

Disclosure would not necessarily jeopardize the doctor-patient relationship, Gallagher believes. "I think health plans and doctors could help educate the public about how patients benefit from these incentives and reinforce their commitment to act as patient advocates," he says. "If there are safeguards in place to make it less likely that incentives cause problems, disclosure could help develop partnerships between doctors and patients for practicing cost-conscious health care."

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Contact: Linda Sage
sage@medicine.wustl.edu
314-286-0119
Washington University in St. Louis
27-Jan-1999