Purpose: With growing pressure to contain health care costs, experts have sought ways to reduce unnecessary testing. But how can patients be persuaded to seek fewer health care services? In this research, we examined whether highlighting the social implications of patients’ medical decisions can reduce their interest in tests of limited value.
Method: 1579 adults (recruited online) were asked to imagine that they were having frequent headaches that they worried might be caused by a tumor. A doctor explained that the headaches were almost certainly migraines, and that a tumor was very unlikely, but an MRI could confirm this. Half of participants were then told that demand for MRIs outpaced the hospital’s capacity, and getting the test might delay testing for another patient. Other participants were not informed of the social implications of getting an MRI. Additionally, half of participants were told that MRIs are costly and often unnecessary, and insurance companies raise their rates in order to cover this unnecessary testing. The rest were not informed of these systemic costs. This resulted in a 2 (Social cost: present vs. absent) X 2 (Systemic costs: present vs. absent) design. Outcome measures included participants’ decision to undergo the MRI or not, and their perceived importance of controlling healthcare costs.
Result: At baseline, 75% of participants wanted the MRI. This was reduced by 11%-18% by highlighting social costs (64%), systemic cost (57%), or both (58%; all p’s<.001 compared to baseline). Furthermore, the effect of social/systemic costs on utilization was moderated by preexisting beliefs about the importance of controlling healthcare costs (p=.01). Participants who believed that controlling healthcare costs is important were significantly influenced by the social/systemic information (reduction in utilization=12-18%), whereas participants who did not share these beliefs showed little or no reduction in utilization (0-6%).
Conclusion: Unnecessary testing is a major problem that contributes to the high cost of care in the US. The present study demonstrated that patient interest in such tests can be quite strong, but that it can be significantly reduced by educating patients about the broader social and systemic impacts of their decisions. Together, these findings suggest that if more of the population comes to believe that overuse is a problem, then describing these costs may drive down overutilization of unnecessary tests.
See more of: The 34th Annual Meeting of the Society for Medical Decision Making