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

Purpose: To examine the extent to which physicians know and consider costs when deciding treatments, and what regulatory regimes or tools they would preferred to make cost awareness a more prominent part of the decision to treat.  

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

Result: 84% agrees that it is the duty of a physician to take costs into consideration when treating patients. However, when asked less abstract questions about specific behavior and preferences for various treatments, they tended to put very little weight on social costs. When asked to estimate the costs of treatments, less than 50% estimated a price within an interval of 50% of the correct price. Most tended to underestimate the cost of expensive interventions and overestimate the cost of cheap interventions. Only 17% had sought information about the cost of a treatment at least once a month during the last year. 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. We analyze differences in motivation and knowledge in the subgroups specialty, demographics and personality-type (Basic Character Inventory).  

Conclusion: Lack of cost-consciousness in the health care system increasingly leads to favoring of patients with less severe health problems at the cost of patients whose only option to be able to carry on leading their lives are medical treatment. As a matter of principle, physicians are in favor of considering costs when treating their patients, but this principle shows difficult to implement in practice due to an array of causes and circumstances. We conclude that cost containment is not caused mainly by doctors’ lack of motivation to consider costs, but by a regulatory system which makes it difficult for doctors both to know and take costs into considerations. Relatively simple information systems have been shown to have some effect, but the main cause, in the view of the physicians, is the weak external regulation.