Discretionary decision making by primary care physicians and the cost of U.S. Health care
- PMID: 18474975
- PMCID: PMC2438037
- DOI: 10.1377/hlthaff.27.3.813
Discretionary decision making by primary care physicians and the cost of U.S. Health care
Abstract
Efforts to improve the quality and costs of U.S. health care have focused largely on fostering physician adherence to evidence-based guidelines, ignoring the role of clinical judgment in more discretionary settings. We surveyed primary care physicians to assess variability in discretionary decision making and evaluate its relationship to the cost of health care. Physicians in high-spending regions see patients back more frequently and are more likely to recommend screening tests of unproven benefit and discretionary interventions compared with physicians in low-spending regions; however, both appear equally likely to recommend guideline-supported interventions. Greater attention should be paid to the local factors that influence physicians' clinical judgment in discretionary settings.
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References
-
- Catlin A, et al. National Health Spending in 2006: A Year of Change for Prescription Drugs. Health Affairs. 2008;27(1):14–29. - PubMed
-
- Banks J, et al. Disease and Disadvantage in the United States and in England. Journal of the American Medical Association. 2006;295(17):2037–2045. - PubMed
- Hoyert DL, et al. Annual Summary of Vital Statistics: 2004. Pediatrics. 2006;117(1):168–183. - PubMed
- Weiss JE, Mushinski M. International Mortality Rates and Life Expectancy: Selected Countries. Statistical Bulletin—Metropolitan Life Insurance Company. 1999;80(1):13–21. - PubMed
-
-
Fisher ES, et al. The Implications of Regional Variations in Medicare Spending, Part 1: The Content, Quality, and Accessibility of Care. Annals of Internal Medicine. 2003;138(4):273–287.Fisher ES, et al. The Implications of Regional Variations in Medicare Spending, Part 2: Health Outcomes and Satisfaction with Care. Annals of Internal Medicine. 2003;138(4):288–298. The same is true when comparing leading academic medical centers. See Wennberg JE, et al. Use of Hospitals, Physician Visits, and Hospice Care during the Last Six Months of Life among Cohorts Loyal to Highly Respected Hospitals in the United States. British Medical Journal. 2004;328(7440):607.Fisher ES, et al. Variations in the Longitudinal Efficiency of Academic Medical Centers. Health Affairs. 2004;23:var19–var32. doi: 10.1377/hlthaff.var.19. published online 7 October 2004.
-
-
- Fisher, et al. The Implications of Regional Variations, Part 2
- Skinner JS, Staiger DO, Fisher ES. Is Technological Change in Medicine Always Worth It? The Case of Acute Myocardial Infarction. Health Affairs. 2006;25:w34–w47. doi: 10.1377/hlthaff.25.w34. published online 7 February 2006. - DOI - PMC - PubMed
-
- Fisher, et al. The Implications of Regional Variations, Part 1
- Fisher, et al. The Implications of Regional Variations, Part 2
- Sirovich BE, et al. Regional Variations in Health Care Intensity and Physician Perceptions of Quality of Care. Annals of Internal Medicine. 2006;144(9):641–649. - PubMed
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