Associations between physician financial incentives and the prescribing of anti-asthmatic medications in children in US outpatient settings

Abstract

This study examined how sociological factors including financial incentives influenced whether asthmatic children received a controller medication, a reliever medication or both. The 2007 National Ambulatory Medical Care Survey was used for this analysis. A logistic regression was applied to capture the physician's decision-making and to analyze anti-asthmatic medication choice. Children with asthma seeing a pediatrician were approximately 69% more likely than children seeing a family doctor to receive a controller medication than reliever medication (p<0.01). Children with asthma enrolled in a capitated plan were 23% more likely to receive controller medications than reliever medications (p<0.01). Children with asthma of Hispanic ethnicity were 28% less likely to receive controller medication compared to non-Hispanic white (p<0.05) children. Compared with physicians with lower financial incentives, physicians who received medium (39%, p<0.05) or higher (42%, p<0.01) financial incentives from payers were more likely to prescribe controller medication than reliever medication for asthmatic children. An important finding of this study is that physicians who had medium or higher financial incentives from payers were about 40% more likely to prescribe a controller medication in asthmatic children. Findings suggest that physician incentives and capitated plans are associated with an increase in physicians prescribing controller medications or preventive care in children with asthma.

Keywords: Child health; chronic illness; decision-making; health services research; medication.