Division of General Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
JAMA. 2013 Jul 24;310(4):380-8. doi: 10.1001/jama.2013.8278.
Physicians' views about health care costs are germane to pending policy reforms.
To assess physicians' attitudes toward and perceived role in addressing health care costs.
DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional survey mailed in 2012 to 3897 US physicians randomly selected from the AMA Masterfile.
Enthusiasm for 17 cost-containment strategies and agreement with an 11-measure cost-consciousness scale.
A total of 2556 physicians responded (response rate = 65%). Most believed that trial lawyers (60%), health insurance companies (59%), hospitals and health systems (56%), pharmaceutical and device manufacturers (56%), and patients (52%) have a "major responsibility" for reducing health care costs, whereas only 36% reported that practicing physicians have "major responsibility." Most were "very enthusiastic" for "promoting continuity of care" (75%), "expanding access to quality and safety data" (51%), and "limiting access to expensive treatments with little net benefit" (51%) as a means of reducing health care costs. Few expressed enthusiasm for "eliminating fee-for-service payment models" (7%). Most physicians reported being "aware of the costs of the tests/treatments [they] recommend" (76%), agreed they should adhere to clinical guidelines that discourage the use of marginally beneficial care (79%), and agreed that they "should be solely devoted to individual patients' best interests, even if that is expensive" (78%) and that "doctors need to take a more prominent role in limiting use of unnecessary tests" (89%). Most (85%) disagreed that they "should sometimes deny beneficial but costly services to certain patients because resources should go to other patients that need them more." In multivariable logistic regression models testing associations with enthusiasm for key cost-containment strategies, having a salary plus bonus or salary-only compensation type was independently associated with enthusiasm for "eliminating fee for service" (salary plus bonus: odds ratio [OR], 3.3, 99% CI, 1.8-6.1; salary only: OR, 4.3, 99% CI, 2.2-8.5). In multivariable linear regression models, group or government practice setting (β = 0.87, 95% CI, 0.29 to 1.45, P = .004; and β = 0.99, 95% CI, 0.20 to 1.79, P = .01, respectively) and having a salary plus bonus compensation type (β = 0.82; 95% CI, 0.32 to 1.33; P = .002) were positively associated with cost-consciousness. Finding the "uncertainty involved in patient care disconcerting" was negatively associated with cost-consciousness (β = -1.95; 95% CI, -2.71 to -1.18; P < .001).
In this survey about health care cost containment, US physicians reported having some responsibility to address health care costs in their practice and expressed general agreement about several quality initiatives to reduce cost but reported less enthusiasm for cost containment involving changes in payment models.
医生对医疗成本的看法与即将出台的政策改革息息相关。
评估医生对医疗成本的态度和在解决医疗成本方面的作用。
设计、地点和参与者：2012 年，从 AMA 主文件中随机抽取的 3897 名美国医生中进行了一项横断面调查。
对 17 种成本控制策略的热情以及对 11 项成本意识量表的认同。
共有 2556 名医生做出了回应（回应率为 65%）。大多数人认为，律师（60%）、医疗保险公司（59%）、医院和医疗系统（56%）、制药和设备制造商（56%）以及患者（52%）对降低医疗成本负有“主要责任”，而只有 36%的医生报告说他们自己负有“主要责任”。大多数人“非常热衷于”通过“促进医疗连续性”（75%）、“扩大获取质量和安全数据的机会”（51%）以及“限制使用没有净收益的昂贵治疗方法”（51%）来降低医疗成本。很少有人对“消除按服务收费模式”（7%）表示热情。大多数医生报告说“了解自己推荐的检查/治疗的费用”（76%），同意他们应该遵守不鼓励使用边际有益护理的临床指南（79%），并同意“他们应该只专注于个体患者的最佳利益，即使这很昂贵”（78%），并且“医生需要在限制不必要的检查使用方面发挥更突出的作用”（89%）。大多数（85%）不同意“有时应该拒绝向某些患者提供有益但昂贵的服务，因为资源应该提供给更需要的其他患者”。在多变量逻辑回归模型中，测试与关键成本控制策略的热情相关联，薪资加奖金或仅薪资补偿类型与对“消除按服务收费”的热情呈独立相关（薪资加奖金：优势比[OR]，3.3，99%置信区间，1.8-6.1；仅薪资：OR，4.3，99%置信区间，2.2-8.5）。在多变量线性回归模型中，团体或政府实践设置（β=0.87，95%置信区间，0.29 至 1.45，P=0.004；和β=0.99，95%置信区间，0.20 至 1.79，P=0.01）和薪资加奖金补偿类型（β=0.82；95%置信区间，0.32 至 1.33；P=0.002）与成本意识呈正相关。发现“患者护理中涉及的不确定性令人不安”与成本意识呈负相关（β=-1.95；95%置信区间，-2.71 至-1.18；P<.001）。
在这项关于医疗成本控制的调查中，美国医生报告说在他们的实践中有一些责任来解决医疗成本问题，并且普遍同意一些降低成本的质量举措，但对涉及支付模式变化的成本控制措施的热情较低。
