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Physicians' interactions with third-party payers: is deception necessary?
Sidney T Bogardus1, David E Geist, Elizabeth H Bradley
1Department of Medicine, Yale University School of Medicine, New Haven, CT 06504, USA. bogardus@ynhh.org
Archives of Internal Medicine
|September 29, 2004
Summary
Physicians may use deception with health insurance payers to secure necessary patient care, especially for severe illnesses or when appeals are difficult. This practice is more common among physicians treating Medicaid or managed care patients.
Area of Science:
- Medical Ethics
- Health Services Research
- Healthcare Policy
Background:
- Physicians sometimes employ deceptive tactics when dealing with third-party payers.
- This behavior may stem from perceived necessity, particularly in cases of severe illness or burdensome appeals processes.
Purpose of the Study:
- To explore the prevalence and implications of physician deception in interactions with third-party payers.
- To understand the factors influencing physicians' willingness to use deceptive tactics.
Main Methods:
- Analysis of published reports and existing studies on physician-payer interactions.
- Review of factors such as patient population (Medicaid, managed care) and illness severity.
Main Results:
- Physicians may deceive payers to ensure necessary care, especially for severe conditions.
- Willingness to deceive is higher among physicians with more Medicaid or managed care patients.
- Deception highlights potential systemic issues in healthcare financing.
Conclusions:
- Physician deception raises concerns for medical professionalism and patient trust.
- The findings suggest potential flaws in healthcare financing systems that create conflicts for physicians.
- Addressing these systemic issues is crucial for rational health policy development.
Keywords:
Health Care and Public Health