Are doctors passing the buck on healthcare costs?


Physicians are concerned about skyrocketing healthcare costs -- but most don’t think they have “major responsibility” for reducing those costs, according to survey results released Tuesday.

Mayo Clinic researcher Dr. Jon C. Tilburt and colleagues polled 2,556 doctors on healthcare costs in 2012, asking them to gauge their level of responsibility for controlling costs -- as well as others’ responsibility. More than half of respondents said that trial lawyers, health insurance companies, hospitals and health systems, pharmaceutical and device manufacturers and patients had a major responsibility for cutting costs. But only 36% said that physicians themselves had major responsibility. More than half said that doctors bore “some responsibility.”

The team also asked doctors to describe how enthusiastic they were about various approaches to cost-containment. Most were very or somewhat enthusiastic about reforms such as promoting quality of care and improving the quality of the data doctors have at their disposal to make better informed treatment decisions.


But “respondents’ ratings for changing how care gets paid for were more mixed,” the team wrote, reporting that physicians were loath to endorse “more substantial financing reforms” like eliminating fee-for-service reimbursement, cutting Medicare pay or imposing penalties when patients have to be readmitted to the hospital.

The researchers called the doctors’ opinions about cost-containment “complex” and “nuanced,” noting that 85% agreed that “trying to contain costs is the responsibility of every physician,” even as 78% agreed with the statement that they “should be solely devoted to my individual patients’ best interests, even it that is expensive.”

A report summarizing the survey results was published in the Journal of the American Medical Assn.

In a related editorial, University of Pennsylvania researchers Dr. Ezekiel J. Emanuel and Andrew Steinmetz called the physicians’ reported attitudes “a denial of responsibility,” writing that many doctors seemed enthusiastic only about cost-cutting efforts that “relieve the physician from being the decision maker.”

“If there ever was an ‘all-hands-on-deck’ moment in the history of health care, now is the time ... physicians must lead,” they wrote.

But, they added, “in the face of this new and uncertain moment in the reform of the health care system, physicians are lapsing into the well-known, cautious instinctual approaches humans adopt whenever confronted by uncertainty: blame others and persevere with ‘business as usual.’ ”


Return to Science Now.