PHYSICIANS AND COSTS: LACK OF INFORMATION OR LACK OF MOTIVATION?

Purpose: To examine the extent to which physicians know and consider costs when determinig diagnosis and deciding treatments

Method: A survey of 1010 physicians combined with information from other surveys and in depth-interviews.

Result: When asked abstract questions about whether they believed they should take social costs into consideration, most physicians agreed. However, when asked less abstract questions there was more disagreement. When asked about specific behaviour and preferences for varous treatment, they tended put very little weight on social costs. When asked about about their knowledge of varoous costs, most tended to underestimate the cost of expensive interventions and overestimate the cost of cheap interventions. Surprisingly the physicians who indicated that they were motivated to consider costs, often did not know more about costs than those who were less motivated.

Conclusion: Cost containment is not caused mainly by doctors lack of motivation to consider costs, but by a regulatory system which makes it difficult for the doctor both to know and take costs into considerations. Relatively simple information systems have been show to have some effect, but the main cause, in the view of the physicians, is the weak external regulation.