A new study by a team of researchers at the University of California San Francisco presents evidence that doctors may withhold needed services from patients in response to financial incentives to control costs.

In a nationwide survey of internists, UCSF researchers also found that up to 50 percent of physicians in managed care settings and 39 percent of physicians in fee-for-service settings failed to prescribe services recommended by national guidelines. The more restrictive the financial incentive, the less likely physicians would order recommended tests or referrals. The study appears in the March issue of the Western Journal of Medicine.

"This study shows that patient care may be compromised regardless of what financial incentives are in place," said Steven Pantilat, M.D., lead author and assistant professor of medicine at UCSF. "That can erode the public's trust." Compared to fee-for-service plans, the restrictions of managed care resulted in a decrease of 3 percent to 11 percent of physicians stating that they would order the appropriate tests and referrals. Although the researchers' findings suggest that incentives in managed care do lead physicians to withhold needed services, financial motives should not be singled out as the only factor influencing doctors' decisions, said Pantilat.

Questionnaires were mailed to 1,030 general internists (70 percent response rate) in group or solo practices across the country who belonged to the American College of Physicians. They practiced in metropolitan areas with populations of more than 250,000 where at least 30 percent of insured people belonged to managed care plans, said Pantilat.

In the survey, physicians were given four patient scenarios and asked to determine whether they would prescribe the test or referral recommended by national guidelines designed to identify or rule out life-threatening illnesses. The physicians made their treatment decisions working under various fictitious combin
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Contact: Rebecca Sladek Nowlis
rnowlis@pubaff.ucsf.edu
415-476-2557
University of California - San Francisco
6-Apr-1999