Patients think payers influence medical care

Yet trust in physicians remains high

More than 40% of Americans think payers’ rules influence physicians’ decisions about their medical care. At the same time, a study released by the Center for Studying Health System Change (HSC) in Washington, DC, found that only 7% of Americans surveyed felt physicians fail to put patients’ needs first.

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

The HCS study, "Patients Concerned about Insurer Influences," examined results from the 1998-1999 Community Tracking Study household survey, a nationally representative telephone survey of roughly 32,000 households and 59,000 individuals.

Findings include the following:

  • 56% of African-Americans and 54% of Hispanics agreed that their physicians were influenced by insurance rules, compared with 40% of whites.
  • 10% of Hispanics agreed that physicians would not put their medical needs first, compared with 7% of African-Americans and 6% of whites.
  • 53% of Americans below the poverty level agreed that physicians are influenced by insurance company rules, compared with 40% of those with incomes at least four times the poverty level.
  • 46% of Americans in fair or poor health agreed that physicians are influenced by insurance company rules, compared with 43% of those in good to excellent health.
  • 9% of Americans in fair or poor health agreed that physicians would not put their medical needs first, compared with 7% of those in good to excellent health.
  • 70% of Americans surveyed "strongly agreed" that their physicians would put medical needs first.

Those figures have remained stable since HCS’ first study in 1997 despite the growing managed care backlash among consumers.

"The challenge to policy-makers 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," says Paul B. Ginsburg, PhD, president of HSC.