Disclosing%20Doctors

1
Disclosing Doctors Incentives

• James G. Anderson, Ph.D.
• Purdue University

2
Physicians Payment Arrangements

• Traditional or fee-for-service Payment for each
  visit, test, and procedure provided.
• Managed care or capitation Fixed monthly
  payment to provide health care services for
  patients who access the system through the
  physician.
• Salary Payment of a fixed yearly amount.

3
Legislation

• 1994 AMA revised the Code of Ethics to state that
  MDs should advise their patients of financial
  incentives.
• 1997 8th Circuit Court of Appeals ruled under
  ERISA that health plans must disclose financial
  incentives for MDs.
• 1998 28states required disclosure of financial
  incentives for MDs.
• 2000 5th Circuit Court of Appeals ruled that
  health plans do not have to disclose financial
  incentives for MDs.

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Arguments for Disclosure by Health Plans

• Enhances choice of plan by consumers
• Helps enrollees to understand how incentives
  affect access and treatment decisions.
• Encourages plans to develop physician
  compensation methods that enhance quality of
  care.

5
Arguments for Disclosures by Doctors

• Satisfies physicians fiduciary duty to patients.
  
• Promotes patient autonomy.
• Preserves physicians integrity and the patient
  relationship.
• Discourages physicians from entering into
  financial arrangements detrimental to patients.

6
Arguments against Disclosure

• Financial incentives under managed care plans are
  complex and difficult for the patient to
  understand.
• Little research on how physicians financial
  incentives affect quality of care.
• Disclosure of financial incentives may lower
  patients trust in their physicians.

7
Patients who Correctly Identified their
Physicians payment Method
8
Other Studies of Knowledge of Physicians
Financial Incentives

• Only 50 of enrollees wanted information about
  incentives
• 37 of enrollees did not understand capitation
• 25 of enrollees in HMOs or PPOs did not know
  their choice of a provider was limited.
• Only about 33 of Medicare beneficiaries believed
  financial incentives influence physicians
  behavior.
• 84 of patients trusted their physicians to put
  patients interests first.