Do Doctors Tailor the Care They Provide Based on the Patient’s Health Plan?
No for primary care, but maybe for specialists according to Jason Shafrin:
According to a paper by Landon et al. (2011), “Physicians in highly capitated practices had the lowest total costs and intensity of care, suggesting that these physicians develop an overall approach to care that also applies to their FFS patients.” The authors used data from the Community Tracking Study Physician Survey to reach this conclusion.
This result, however, was only shown to hold for primary care physicians. The reimbursement differences for each individual patient may be smaller than the physician’s time (and psychic) cost to determine each patient’s payor and alter their recommended treatment regimen accordingly. Thus, this conclusion makes sense for PCPs.
For specialists, however, this conclusion may or may not hold. Particularly, for specialists who generally provide expensive procedures, altering care recommendations for individual patients based on their insurance coverage could have a very significant effect on the practice’s bottom line.
Specialists providing advanced care typically don’t make things up as they go along, so varying recommended care to respond to financial incentives might also have bad effects on patients. One wonders what the outcome measures were in this study. They aren’t described in the abstract.
The sample was 2,211 internists and family practice physicians so the results hold only for that group.
I would assume doctors tailor care to their patients’ insurance plan to some degree. Why is it difficult to get your doctor on the phone? Answer: because your insurer doesn’t pay your doctor for phone consultations.
I always thought that my doctor couldn’t come to the phone because he was seeing patients.
The physicians I see do return calls. They also provide medically trained office staff to answer simple questions.
I would imagine that a lot of people don’t have a strong enough grasp of medical science to know when they are being unjustifiably shorted of care because of the limitations of their insurance plan. The people that know the most are the doctors and the insurance providers.
On some level, it’s up to people to know their bodies and health history well enough and use that knowledge to guide them towards choosing a better company and/or policy. That won’t guarantee that they will get better coverage and treatment when they need it, but it may improve the chances of it.
The research leads to conclusions that I would describe as commonsensical (which is not to say it is not valuable). Unfortunately, this kind of research is dangerous in the wrong hands, i.e. the hands of policymakers and politicians, because they will just conclude that the state should impose capitation throughout “the system.”
Doctors choose whether to practice in a capitated system or FFS. In California, you can become a “Kaiser doc” or join a PPO (or become a concierge doctor). I submit that the doctor herself has a preferred way of practicing and that causes the doctor to choose the environment, not (so much) that the environment creates the doctor’s behavior.
For example, if a patient enrolled in a PPO plan goes to a Kaiser doctor because the Kaiser health plaza is closer to home, the Kaiser doctor will treat her the same as a Kaiser patient. However, if the state then drives all the doctors to become Kaiser doctors, the ones who were in private practice will likely “rebel” against the constraints.
Does that makes sense?