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Controlling Health Costs: Physician Responses to Patient Expectations for Medical Care

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ABSTRACT

BACKGROUND

Physicians have dual responsibilities to make medical decisions that serve their patients’ best interests but also utilize health care resources wisely. Their ability to practice cost-consciously is particularly challenged when faced with patient expectations or requests for medical services that may be unnecessary.

OBJECTIVE

To understand how physicians consider health care resources and the strategies they use to exercise cost-consciousness in response to patient expectations and requests for medical care.

DESIGN

Exploratory, qualitative focus groups of practicing physicians were conducted. Participants were encouraged to discuss their perceptions of resource constraints, and experiences with redundant, unnecessary and marginally beneficial services, and were asked about patient requests or expectations for particular services.

PARTICIPANTS

Sixty-two physicians representing a variety of specialties and practice types participated in nine focus groups in Michigan, Ohio, and Minnesota in 2012

MEASUREMENTS

Iterative thematic content analysis of focus group transcripts

PRINCIPAL FINDINGS

Physicians reported making trade-offs between a variety of financial and nonfinancial resources, considering not only the relative cost of medical decisions and alternative services, but the time and convenience of patients, their own time constraints, as well as the logistics of maintaining a successful practice. They described strategies and techniques to educate patients, build trust, or substitute less costly alternatives when appropriate, often adapting their management to the individual patient and clinical environment.

CONCLUSIONS

Physicians often make nuanced trade-offs in clinical practice aimed at efficient resource use within a complex flow of clinical work and patient expectations. Understanding the challenges faced by physicians and the strategies they use to exercise cost-consciousness provides insight into policy measures that will address physician’s roles in health care resource use.

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Acknowledgements

The authors would like to thank Greenwall Foundation for the support of this work.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Author information

Authors and Affiliations

  1. Department of Emergency Medicine, University of Michigan, NCRC,2800 Plymouth Rd, Building 10, Room G015, Ann Arbor, MI, 48109-2800, USA

    Amber K. Sabbatini MD, MPH

  2. Division of General Internal Medicine, Mayo Clinic, Rochester, MN, USA

    Jon C. Tilburt MD

  3. Biomedical Ethics Research Unit, Mayo Clinic, Rochester, MN, USA

    Jon C. Tilburt MD

  4. Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA

    Jon C. Tilburt MD & Jason S. Egginton MPH

  5. Department of Medicine, Harvard Medical School, Boston, MA, USA

    Eric G. Campbell PhD

  6. Mongan Institute for Health Policy, Massachusetts General Hospital, Boston, MA, USA

    Eric G. Campbell PhD

  7. Department of Family Medicine, Mayo Clinic, Rochester, MN, USA

    Robert D. Sheeler MD

  8. Department of Medicine and Health Management and Policy, University of Michigan, Ann Arbor, MI, USA

    Susan D. Goold MD, MHSA, MA

  9. Center for Bioethics and Social Sciences in Medicine, Ann Arbor, MI, USA

    Susan D. Goold MD, MHSA, MA

Authors
  1. Amber K. Sabbatini MD, MPH
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  2. Jon C. Tilburt MD
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  3. Eric G. Campbell PhD
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  4. Robert D. Sheeler MD
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  5. Jason S. Egginton MPH
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  6. Susan D. Goold MD, MHSA, MA
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Corresponding author

Correspondence to Amber K. Sabbatini MD, MPH.

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Sabbatini, A.K., Tilburt, J.C., Campbell, E.G. et al. Controlling Health Costs: Physician Responses to Patient Expectations for Medical Care. J GEN INTERN MED 29, 1234–1241 (2014). https://doi.org/10.1007/s11606-014-2898-6

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  • DOI: https://doi.org/10.1007/s11606-014-2898-6

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