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Diagnostic test use in different practice settings. A controlled comparison
Insights
Health maintenance organizations (HMOs) reduce diagnostic testing for chest pain compared to other settings. This impacts recommendations for costly procedures like coronary bypass surgery, influencing overall healthcare costs.
Area of Science:
- Cardiology
- Health Services Research
- Healthcare Economics
Background:
- Health maintenance organizations (HMOs) are known for lower medical care costs, but the underlying reasons are debated.
- Understanding variations in diagnostic and treatment practices is crucial for healthcare cost containment.
Observation:
- A survey compared diagnostic practices of cardiologists in an HMO, a university, and a community setting.
- Cardiologists defined indications for coronary bypass surgery and evaluated patient case summaries.
- They rated the necessity of exercise thallium scintigraphy and coronary angiography.
Findings:
- Community cardiologists exhibited broader indications for coronary bypass surgery.
- HMO cardiologists utilized thallium scintigraphy significantly less than university or community cardiologists.
- HMO and university cardiologists recommended coronary angiography less frequently than community cardiologists.
Implications:
- Physician practice settings significantly influence recommendations for costly diagnostic and therapeutic cardiac procedures.
- Variations in diagnostic intensity may contribute to cost differences observed in different healthcare systems.
- Standardizing practice patterns for identical patient cases could optimize resource allocation and reduce unnecessary healthcare expenditures.
Abstract:
Health maintenance organizations (HMOs) have lower than average medical care costs, but the reasons remain controversial. The diagnostic practices of cardiologists from an HMO, a university, and a community were therefore surveyed. First, cardiologists defined indications for coronary bypass surgery and then evaluated randomly selected case summaries of patients with chest pain. After review, the cardiologist rated the need for an exercise thallium scintiscan and for a coronary angiogram in each case. Community cardiologists had the broadest indications for bypass surgery. The HMO cardiologists chose thallium scintigraphy significantly less often than the other two types of cardiologists did. The HMO and university cardiologists both rated the need for coronary angiography significantly lower than did community cardiologists. Physicians in different practice settings therefore recommend costly diagnostic and therapeutic methods differently, even for identical patients.