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A survey of physician attitudes and practices concerning cost-effectiveness in patient care
M E Ginsburg1, R L Kravitz, W A Sandberg
1Sacramento Healthcare Decisions, 4747 Engle Rd Carmichael, CA 95608, USA. marge.shd@quik.net.com
Objective:
To identify physicians' views regarding cost-containment and cost-effectiveness and their attitudes and experience using cost-effectiveness in clinical decision making.
Design:
A close-ended 30-item written survey.
Subjects:
1,000 randomly selected physicians whose practices currently encompass direct patient care and who work in the California counties of Sacramento, Yolo, Placer, Nevada, and El Dorado.
Outcome Measures:
Physician attitudes about the role of cost and cost-effectiveness in treatment decisions, perceived barriers to cost-effective medical practice, and response of physicians and patients if there are conflicts about treatment that physicians consider either not indicated or not cost-effective.
Results:
Most physicians regard cost-effectiveness as an appropriate component of clinical decisions and think that only the treating physician and patient should decide what is cost-worthy. However, physicians are divided on whether they have a duty to offer medical interventions with remote chances of benefit regardless of cost, and they vary considerably in their interactions with patients when cost-effectiveness is an issue.
Conclusion:
Although physicians in the Sacramento region accept cost-effectiveness as important and appropriate in clinical practice, there is little uniformity in how cost-effectiveness decisions are implemented.
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