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Differences in physician compensation for cardiovascular services by age, sex, and race
H M Krumholz1, A M Fendrick, C Williams
1Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT 06510, USA.
Insights
Physicians receive significantly less payment for cardiovascular services from older, female, and nonwhite patients. These disparities are primarily linked to differences in insurance coverage, not procedure charges.
Area of Science:
- Cardiology
- Health Economics
- Health Disparities
Background:
- Certain patient demographics, including older adults, women, and nonwhite individuals, are known to have lower utilization rates of cardiovascular services.
- Understanding physician compensation patterns across different patient groups is crucial for addressing potential inequities in healthcare delivery.
Purpose of the Study:
- To investigate whether physicians receive substantially less compensation from patient groups with historically low cardiovascular service utilization.
- To analyze payment differences based on patient age, sex, and race for cardiovascular procedures.
Main Methods:
- Retrospective analysis of payment data from 3,194 stress tests and 833 percutaneous coronary angioplasties.
- Data collected over an 18-month period at Yale University Cardiology Practice.
- Examination of payment variations in relation to patient age, sex, and race.
Main Results:
- Significant differences in physician payments were observed based on patient age, sex, and race, despite uniform procedure charges.
- For percutaneous transluminal coronary angioplasty, physician payments were received from 72% of 40-64 year olds vs. 3% of those 75+.
- Similar disparities were noted for stress testing, with insurance status largely explaining these associations.
Conclusions:
- Physician compensation for cardiovascular services varies significantly across different patient demographic groups.
- Observed payment disparities are strongly associated with differences in patient insurance status.
- Further research is needed to address systemic factors contributing to these inequities in cardiovascular care.
Abstract:
The purpose was to determine whether physicians receive substantially less compensation from patient groups (women, older patients, and nonwhite patients) that are reported to have low rates of utilization of cardiovascular services. Over an 18-month period we collected information on payments to physicians by 3,194 consecutive patients who underwent stress testing an 833 consecutive patients who underwent percutaneous coronary angioplasty at the Yale University Cardiology Practice. Although the charges for procedures were not related to patient characteristics, there were large and significant differences in payment to physicians based on age, sex, and race. For example, physicians who performed percutaneous transluminal coronary angioplasty received at least $2,500 from, or on behalf of, 72% of the patients 40 to 64 years old, 22% of the patients 65 to 74 years old, and 3% of the patients 75 years and older (P < 0.001); from 49% of the men and 28% of the women (P < 0.001); and 42% of the whites and 31% of the nonwhites (P < 0.001). Similar differences were observed for stress testing. These associations were largely explained by differences in insurance status.