Wednesday, September 16, 2009

Physicians’ Beliefs and U.S. Health Care Reform — A National Survey | Health Care Reform 2009

Ryan M. Antiel, M.A., Farr A. Curlin, M.D., Katherine M. James, M.P.H., and Jon C. Tilburt, M.D., M.P.H. in New England Journal of Medicine

Previous research suggests that physicians endorse a public role for the profession and believe they have an obligation to care for people with limited resources. But it remains unclear whether physicians in 2009 see participation in the formation of health policy as part of their professional responsibility or accept the potential consequences of reform. Furthermore, individual physicians may have strong financial incentives to downplay their responsibility for caring for the uninsured and underinsured. Although physicians tend to agree in the abstract that health care resources should be distributed fairly, they may be unwilling to endorse concrete policies that expand coverage for basic health care by limiting reimbursement for costly interventions. And despite widespread discussions about using cost-effectiveness data or comparative-effectiveness research to guide clinical decisions, physicians may remain skeptical about such practices.3,4 Thus, physicians may not be willing to take on the role that the President and health policy advocates want them to play.

In May 2009, we mailed a confidential questionnaire to 2000 practicing U.S. physicians, 65 years of age or younger, from all specialties in order to explore these issues. (Detailed information about our methods appears in the Supplementary Appendix, available with the full text of this article at NEJM.org.) As part of an eight-page, self-administered survey on moral and ethical beliefs in medical practice, physicians completed four items that bear directly on broad themes in the current health care reform debate, though the questions were not tied to any specific proposal or position. Respondents were asked to indicate their degree of agreement or disagreement with the following statements:

“Addressing societal health policy issues, as important as that may be, falls outside the scope of my professional obligations as a physician,”

“Every physician is professionally obligated to care for the uninsured and underinsured,” and

“I would favor limiting reimbursement for expensive drugs and procedures if that would help expand access to basic health care for those currently lacking such care.”

Then, as part of a longer list of potentially controversial medical practices, we asked physicians to indicate whether they had no moral objection, a moderate moral objection, or a strong moral objection to “using cost-effectiveness data to determine which treatments will be offered to patients.”

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