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Wednesday, 18 October 2006


David O. Meltzer, MD, PhD1, Micah T. Prochaska, BA1, Benjamin Vekhter, PhD1, Vineet Arora, MD, MA1, Tosha Wetterneck, MD2, Jeffrey Schnipper, MD, MPH3, Andrew Auerbach, MD, MPH4, Peter Kaboli, MD, MS5, and David Gonzales, MD6. (1) University of Chicago, Chicago, IL, (2) University of Wisconsin, Madison, WI, (3) Brigham and Women's Hospital and Harvard Medical School, Boston, MA, (4) University of California San Francisco, San Francisco, CA, (5) University of Iowa, Iowa City, IA, (6) University of New Mexico, Albuquerque, NM

Purpose: To determine patients' preferences to have their inpatient general medical care led by their primary care physician (PCP) compared to a hospitalist or non-hospitalist ward attending, and their willingness to pay (WTP) for their preference among these choices.

Methods: From July 1, 2001 to June 30, 2003 patients were admitted to the general medicine services at 6 academic medical centers and assigned to a hospitalist or non-hospitalist ward attending based on a predetermined call schedule. Patients were called by phone 30 days after discharge and asked whether, for future hospitalizations, they would prefer care by their PCP, or a hospital attending similar to the one who had just cared for them in the hospital. Patients were then asked to report their WTP to receive care from their preferred type of physician.

Results: 10,094 patients reported having a PCP and completed the phone interview. Of these, 37% were cared for by a hospitalist ward attending and 63% by a non-hospitalist ward attending. 53% expressed no preference between receiving care for a future hospitalization from their PCP versus a ward attending, 24% said they would prefer their PCP, and 23% said they would prefer a ward attending. These fractions did not differ between patients cared for by hospitalist and non-hospitalist attendings. 77% of patients expressed a $0 WTP for their preference. Some patients expressed high WTP, including 6% whose WTP equalled or exceeded recent estimates of $400 per admission cost-savings from hospitalists. If a $400 copayment system was used to allow patients with a strong preference for their PCP to choose their PCP while having care by hospitalists be the default option for inpatient general medical care, the per capita welfare cost from the perspective of patient preferences would be only $9/admission, leaving net savings of $391/admission from the use of hospitalists.

Conclusion: Most patients are unwilling to pay for care by their PCP compared to a hospitalist or non-hospitalist ward attending. However, some patients report valuing hospital care from their PCP to a level that exceeds the cost-savings from hospitalists. Requiring a copayment for patients to receive hospital care from their PCP may be an effective method to improve efficiency while respecting the values of patients with a strong preference for care by their PCP.

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See more of The 28th Annual Meeting of the Society for Medical Decision Making (October 15-18, 2006)