Physicians aren't much better at choosing high-value care than patients, study finds

Lack of medical and cost information among patients doesn't necessarily make them worse off than physicians when it comes to choosing the highest-quality service at the lowest cost, according to a working National Bureau of Economic Research paper.

The paper, "Is Great Information Good Enough? Evidence from Physicians as Patients," dissected the "widespread" belief that a lack of understanding among patients is "the [emphasis in original] key barrier to achieving high-quality health outcomes and lower costs of care." NBER working papers are not peer-reviewed and are published for comment and discussion purposes.

Authors Michael Frakes, PhD, of Duke University in Durham, N.C.; Anupam Jena, MD, PhD, of Boston-based Harvard Medical School; and Jonathan Gruber, PhD, of the Massachusetts Institute of Technology in Cambridge, pointed to numerous health policies like healthier diet campaigns, vaccine education and high-deductible health plans as some of the initiatives put in place to further equip patients with more medical knowledge in an attempt to improve quality and cost.

To analyze whether education really is the key barrier to choosing the best care, the researchers studied the role of physicians — who are likely to be the most informed about healthcare procedures and payment — as patients. The authors aimed to answer the question: "Do especially well-informed patients elect to receive higher-value medical services?" To do so, they examined data from the Department of Defense's Military Health System in Falls Church, Va., including claims records from more than 35,000 military physicians.

The researchers found that across low-value settings, physicians did receive fewer low-value services than nonphysician patients. However, the differences "are modest," according to the researchers, and represent less than one-fifth of the gap between recommended guidelines and what nonphysician patients receive. In terms of high-value care, the authors found some evidence to suggest that physicians receive high-value care at about the same rate as nonphysician patients, and they do only slightly better than nonphysician patients. 

"Our results consistently suggest that, at most, superior patient knowledge is associated with only modest improvements in the quality of care selected during medical encounters," the researchers concluded.

For the full working paper, click here.

More articles on integration and physician issues:
California physicians must verbally tell patients if they are on probation for wrongdoing
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27% of cardiologists report burnout

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