James E. Rogers College of Law at University of Arizona.
J Law Med Ethics. 2012 Fall;40(3):452-66. doi: 10.1111/j.1748-720X.2012.00678.x.
This paper explores the empirical evidence regarding the impact financial relationships on the behavior of health care providers, specifically, physicians. We identify and synthesize peer-reviewed data addressing whether financial incentives are causally related to patient outcomes and health care costs. We cover three main areas where financial conflicts of interest arise and may have an observable relationship to health care practices: (1) physicians' roles as self-referrers, (2) insurance reimbursement schemes that create incentives for certain clinical choices over others, and (3) financial relationships between physicians and the drug and device industries. We found a well-developed scientific literature consisting of dozens of empirical studies, some that allow stronger causal inferences than others, but which altogether show that such financial conflicts of interests can, and sometimes do, impact physicians' clinical decisions. Further research is warranted to document the causal relationship of such changes on health outcomes and the cost of care, but the current base of evidence is sufficiently robust to motivate policy reform.
本文探讨了金融关系对医疗保健提供者（特别是医生）行为的影响的经验证据。我们确定并综合了同行评议的数据，以确定经济激励措施是否与患者的结果和医疗成本有因果关系。我们涵盖了三个主要的金融利益冲突领域，这些领域可能与医疗实践有明显的关系：（1）医生作为自我转诊者的角色，（2）保险报销计划，这些计划为某些临床选择创造了激励，而不是其他选择，（3）医生与药品和医疗器械行业之间的财务关系。我们发现了一个非常发达的科学文献，其中包括数十项实证研究，其中一些研究可以做出更强的因果推断，但总的来说，这些研究表明，这种财务利益冲突确实会影响医生的临床决策。有必要进一步研究此类变化对健康结果和医疗成本的因果关系，但目前的证据基础足够强大，可以推动政策改革。
