Controlling health costs

Physician responses to patient expectations for medical care

Amber K. Sabbatini, Jon C Tilburt, Eric G. Campbell, Robert D. Sheeler, Jason S. Egginton, Susan D. Goold

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

BACKGROUND: Physicians have dual responsibilities to make medical decisions that serve their patients' best interests but also utilize health care resources wisely. Their ability to practice cost-consciously is particularly challenged when faced with patient expectations or requests for medical services that may be unnecessary. OBJECTIVE: To understand how physicians consider health care resources and the strategies they use to exercise cost-consciousness in response to patient expectations and requests for medical care. DESIGN: Exploratory, qualitative focus groups of practicing physicians were conducted. Participants were encouraged to discuss their perceptions of resource constraints, and experiences with redundant, unnecessary and marginally beneficial services, and were asked about patient requests or expectations for particular services. PARTICIPANTS: Sixty-two physicians representing a variety of specialties and practice types participated in nine focus groups in Michigan, Ohio, and Minnesota in 2012 MEASUREMENTS: Iterative thematic content analysis of focus group transcripts PRINCIPAL FINDINGS: Physicians reported making trade-offs between a variety of financial and nonfinancial resources, considering not only the relative cost of medical decisions and alternative services, but the time and convenience of patients, their own time constraints, as well as the logistics of maintaining a successful practice. They described strategies and techniques to educate patients, build trust, or substitute less costly alternatives when appropriate, often adapting their management to the individual patient and clinical environment. CONCLUSIONS: Physicians often make nuanced trade-offs in clinical practice aimed at efficient resource use within a complex flow of clinical work and patient expectations. Understanding the challenges faced by physicians and the strategies they use to exercise cost-consciousness provides insight into policy measures that will address physician's roles in health care resource use.

Original languageEnglish (US)
Pages (from-to)1234-1241
Number of pages8
JournalJournal of General Internal Medicine
Volume29
Issue number9
DOIs
StatePublished - 2014

Fingerprint

Health Care Costs
Physicians
Health Resources
Focus Groups
Costs and Cost Analysis
Delivery of Health Care
Consciousness
Exercise
Physician's Role
Aptitude

Keywords

  • cost-conscious care
  • health care costs
  • physician decision-making
  • physician stewardship

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Controlling health costs : Physician responses to patient expectations for medical care. / Sabbatini, Amber K.; Tilburt, Jon C; Campbell, Eric G.; Sheeler, Robert D.; Egginton, Jason S.; Goold, Susan D.

In: Journal of General Internal Medicine, Vol. 29, No. 9, 2014, p. 1234-1241.

Research output: Contribution to journalArticle

Sabbatini, Amber K. ; Tilburt, Jon C ; Campbell, Eric G. ; Sheeler, Robert D. ; Egginton, Jason S. ; Goold, Susan D. / Controlling health costs : Physician responses to patient expectations for medical care. In: Journal of General Internal Medicine. 2014 ; Vol. 29, No. 9. pp. 1234-1241.
@article{a7c2573defc34addbba4f3bffe860d05,
title = "Controlling health costs: Physician responses to patient expectations for medical care",
abstract = "BACKGROUND: Physicians have dual responsibilities to make medical decisions that serve their patients' best interests but also utilize health care resources wisely. Their ability to practice cost-consciously is particularly challenged when faced with patient expectations or requests for medical services that may be unnecessary. OBJECTIVE: To understand how physicians consider health care resources and the strategies they use to exercise cost-consciousness in response to patient expectations and requests for medical care. DESIGN: Exploratory, qualitative focus groups of practicing physicians were conducted. Participants were encouraged to discuss their perceptions of resource constraints, and experiences with redundant, unnecessary and marginally beneficial services, and were asked about patient requests or expectations for particular services. PARTICIPANTS: Sixty-two physicians representing a variety of specialties and practice types participated in nine focus groups in Michigan, Ohio, and Minnesota in 2012 MEASUREMENTS: Iterative thematic content analysis of focus group transcripts PRINCIPAL FINDINGS: Physicians reported making trade-offs between a variety of financial and nonfinancial resources, considering not only the relative cost of medical decisions and alternative services, but the time and convenience of patients, their own time constraints, as well as the logistics of maintaining a successful practice. They described strategies and techniques to educate patients, build trust, or substitute less costly alternatives when appropriate, often adapting their management to the individual patient and clinical environment. CONCLUSIONS: Physicians often make nuanced trade-offs in clinical practice aimed at efficient resource use within a complex flow of clinical work and patient expectations. Understanding the challenges faced by physicians and the strategies they use to exercise cost-consciousness provides insight into policy measures that will address physician's roles in health care resource use.",
keywords = "cost-conscious care, health care costs, physician decision-making, physician stewardship",
author = "Sabbatini, {Amber K.} and Tilburt, {Jon C} and Campbell, {Eric G.} and Sheeler, {Robert D.} and Egginton, {Jason S.} and Goold, {Susan D.}",
year = "2014",
doi = "10.1007/s11606-014-2898-6",
language = "English (US)",
volume = "29",
pages = "1234--1241",
journal = "Journal of General Internal Medicine",
issn = "0884-8734",
publisher = "Springer New York",
number = "9",

}

TY - JOUR

T1 - Controlling health costs

T2 - Physician responses to patient expectations for medical care

AU - Sabbatini, Amber K.

AU - Tilburt, Jon C

AU - Campbell, Eric G.

AU - Sheeler, Robert D.

AU - Egginton, Jason S.

AU - Goold, Susan D.

PY - 2014

Y1 - 2014

N2 - BACKGROUND: Physicians have dual responsibilities to make medical decisions that serve their patients' best interests but also utilize health care resources wisely. Their ability to practice cost-consciously is particularly challenged when faced with patient expectations or requests for medical services that may be unnecessary. OBJECTIVE: To understand how physicians consider health care resources and the strategies they use to exercise cost-consciousness in response to patient expectations and requests for medical care. DESIGN: Exploratory, qualitative focus groups of practicing physicians were conducted. Participants were encouraged to discuss their perceptions of resource constraints, and experiences with redundant, unnecessary and marginally beneficial services, and were asked about patient requests or expectations for particular services. PARTICIPANTS: Sixty-two physicians representing a variety of specialties and practice types participated in nine focus groups in Michigan, Ohio, and Minnesota in 2012 MEASUREMENTS: Iterative thematic content analysis of focus group transcripts PRINCIPAL FINDINGS: Physicians reported making trade-offs between a variety of financial and nonfinancial resources, considering not only the relative cost of medical decisions and alternative services, but the time and convenience of patients, their own time constraints, as well as the logistics of maintaining a successful practice. They described strategies and techniques to educate patients, build trust, or substitute less costly alternatives when appropriate, often adapting their management to the individual patient and clinical environment. CONCLUSIONS: Physicians often make nuanced trade-offs in clinical practice aimed at efficient resource use within a complex flow of clinical work and patient expectations. Understanding the challenges faced by physicians and the strategies they use to exercise cost-consciousness provides insight into policy measures that will address physician's roles in health care resource use.

AB - BACKGROUND: Physicians have dual responsibilities to make medical decisions that serve their patients' best interests but also utilize health care resources wisely. Their ability to practice cost-consciously is particularly challenged when faced with patient expectations or requests for medical services that may be unnecessary. OBJECTIVE: To understand how physicians consider health care resources and the strategies they use to exercise cost-consciousness in response to patient expectations and requests for medical care. DESIGN: Exploratory, qualitative focus groups of practicing physicians were conducted. Participants were encouraged to discuss their perceptions of resource constraints, and experiences with redundant, unnecessary and marginally beneficial services, and were asked about patient requests or expectations for particular services. PARTICIPANTS: Sixty-two physicians representing a variety of specialties and practice types participated in nine focus groups in Michigan, Ohio, and Minnesota in 2012 MEASUREMENTS: Iterative thematic content analysis of focus group transcripts PRINCIPAL FINDINGS: Physicians reported making trade-offs between a variety of financial and nonfinancial resources, considering not only the relative cost of medical decisions and alternative services, but the time and convenience of patients, their own time constraints, as well as the logistics of maintaining a successful practice. They described strategies and techniques to educate patients, build trust, or substitute less costly alternatives when appropriate, often adapting their management to the individual patient and clinical environment. CONCLUSIONS: Physicians often make nuanced trade-offs in clinical practice aimed at efficient resource use within a complex flow of clinical work and patient expectations. Understanding the challenges faced by physicians and the strategies they use to exercise cost-consciousness provides insight into policy measures that will address physician's roles in health care resource use.

KW - cost-conscious care

KW - health care costs

KW - physician decision-making

KW - physician stewardship

UR - http://www.scopus.com/inward/record.url?scp=84906934182&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84906934182&partnerID=8YFLogxK

U2 - 10.1007/s11606-014-2898-6

DO - 10.1007/s11606-014-2898-6

M3 - Article

VL - 29

SP - 1234

EP - 1241

JO - Journal of General Internal Medicine

JF - Journal of General Internal Medicine

SN - 0884-8734

IS - 9

ER -