From Our 2013 Archives
Most Docs Don't Think They're Big Part of Rising Health Care CostsBy Amy Norton
Latest MedicineNet News
TUESDAY, July 23 (HealthDay News) -- While U.S. doctors say it's important to control soaring health care costs, they don't think they are the ones responsible for doing so, new research finds.
The survey, of more than 2,500 physicians, found wide support for certain cost-cutting ideas, such as "promoting continuity of care."
But when it came to taking responsibility for cost control, only 36 percent agreed that doctors have a "major" role to play, researchers report in the July 24/31 issue of the Journal of the American Medical Association.
Instead, doctors more often pointed the finger at insurers, trial lawyers, drug companies, hospitals and patients.
And few doctors supported moves that would curb their incomes: Only 30 percent were at least "somewhat enthusiastic" about eliminating the fee-for-service system of paying doctors. Just 6 percent supported Medicare payment cuts to doctors.
Everyone -- from health care systems to the public -- has to pitch in to control costs, according to lead researcher Dr. Jon Tilburt, of the Mayo Clinic in Rochester, Minn.
And in defense of doctors, he said the vast majority thought they bore at least "some" responsibility for cost-cutting; only 4 percent said it was not their job at all.
"My take-away is, physicians don't want to be singled out," Tilburt said. "There are a lot of stakeholders in this, and physicians want them to take responsibility."
Plus, he added, "it's also just human nature to blame other people."
A doctor not involved in the study agreed that it's human nature to blame the other guy, but said he was "disappointed" in survey respondents' attitudes.
"Every doctor I know wants to be the captain of his own ship," said Dr. Ezekiel Emanuel, of the University of Pennsylvania in Philadelphia. "If you want to be the captain, you've got to take responsibility for cost control."
"It's doctors who order tests and treatments, and decide how often patients are seen in the office," said Emanuel, who wrote an editorial published with the study. "It's hard to see who else is more responsible for cost control."
The findings are based on surveys mailed to almost 3,900 U.S. doctors across different specialties; 65 percent of them responded.
Overall, doctors believed cost-cutting was important and that they had a role; 89 percent, for instance, agreed that doctors need to do more to limit unnecessary medical tests.
But in the big picture, 56 percent to 60 percent said hospitals, drug companies, insurance plans and trial lawyers had a "major responsibility" for cutting health care costs. And 52 percent said the same of patients.
And many of the cost-cutting ideas that doctors liked are "vague," Emanuel said. Most supported "rooting out fraud and abuse," and efforts to improve coordination among a patient's different providers -- to help curb medical mistakes and avoid redundant visits and tests.
"But who wouldn't support those things?" Emanuel said. The problem, he added, is that no one knows if those types of changes will actually save money.
"I think it's necessary to change the payment structure for medical care," Emanuel said. "It's not the only step that's needed, but it's a necessary one."
Tilburt sympathized with the views expressed in the survey. "I think what doctors see on the news is a lot of discussion of Medicare payment cuts, or penalizing providers" for avoidable readmissions to the hospital.
It may feel, Tilburt said, like doctors are being asked to "take their lumps" while no one else is.
It makes sense, he added, that doctors would support potentially "win-win" ideas. "The hope is that making health care leaner and smarter will improve quality, and help bend the cost curve," Tilburt said.
He agreed, though, that no one knows whether "leaner and meaner" will mean cheaper.
Tilburt had an additional take on the survey findings. "A common question for patients is, how is my care going to be affected by 'ObamaCare?'" he said, noting that some people suspect that under the new health care reform law, doctors will start withholding needed tests and treatments in the name of saving dollars.
"That's not true," Tilburt said. "Doctors say they'll choose their patients over health care costs." More than three-quarters, for example, agreed that they should be "solely devoted" to their individual patient's best interests.
"For people who are worried about [health care reform]," Tilburt said. "I think that's reassuring."
SOURCES: Jon Tilburt, M.D., M.P.H., associate professor, biomedical ethics and medicine, Mayo Clinic, Rochester, Minn.; Ezekiel Emanuel, M.D., Ph.D., chair, medical ethics and health policy, University of Pennsylvania School of Medicine, Philadelphia; July 24/31, 2013, Journal of the American Medical Association
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