When it comes to controlling the country’s health care costs, doctors point their fingers at lawyers, insurance companies, drug makers and hospitals. But well over half acknowledge they have at least some responsibility as stewards of health care resources.
In a study, published Tuesday in the Journal of the American Medical Association, Mayo Clinic researchers surveyed more than 2,500 doctors to assess their views of different approaches to rein in the nation’s health care costs. The doctors were randomly selected from an American Medical Association database.
Based on their findings, 59 percent of doctors believed they have some responsibility in holding down health care costs. Only 36 percent thought they have a major role.
More than half of doctors, however, said each of five other groups carry “major responsibility:” trial lawyers, health insurance companies, pharmaceutical companies, hospitals and patients.
“What physicians are trying to tell us is that they don’t see themselves as necessarily any more responsible for health care costs than all of those stakeholders,” said Dr. Jon Tilburt, an associate professor at the Mayo Clinic and the study’s lead author. “They see themselves as a contributor, not a main contributor,” he added.
When asked about options to reduce health care costs, most doctors viewed efforts to improve the quality and efficiency of care most favorably. For example, 98 percent are enthusiastic about efforts to promote care coordination for people with chronic diseases. Doctors were also mostly in favor of improving conditions for evidence-based decisions, including efforts to prevent corporate influence of physicians’ decisions and promoting head-to-head trials of competing treatments.
They were less enthusiastic about changing current payment models. Only 7 percent, for example, were very enthusiastic about eliminating the traditional fee-for-service payment system, while another 23 percent were somewhat enthusiastic. About a third of the physicians expressed enthusiasm for bundled payment systems.
Though about one in three doctors think they have major responsibility, the survey shows that doctors recognize they do have a role in addressing health care costs, said Dr. Jay Crosson, the American Medical Association’s vice president of professional satisfaction, care delivery and payment.
“These are all really good things, and sometimes people don’t recognize the positivity that exists in the physician community,” Crosson added.
Tilburt also said the results cast a positive light on doctors.
Close to 80 percent, for example, felt that they should be solely devoted to their patients’ best interests, regardless of cost. “They will choose taking care of the patients over eliminating health care costs,” Tilburt said.
Only 16 percent of the doctors said they agreed that they “should sometimes deny beneficial, but costly services to certain patients because resources should go to other patients that need them more.” At the same time, nearly one in nine of the doctors said they need to take “a more prominent role” in limiting unnecessary tests.
Tilburt says some doctors worry the health law might have incentives that would prevent them from doing enough for patients. “I don’t think that’s the intent of many of these reforms, but I think physicians are nervous and they need to be shown where are the win-win strategies that’s good for individual patients and for society,” he said.