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Do physicians not offer useful services because of coverage restrictions?

Health affairs (Project Hope)

United States, American Medical Association, Attitude of Health Personnel, Communication, Decision Making, Ethics, Medical, Health Care Surveys, Health Services Accessibility, economics, ethics, Humans, Insurance Coverage, standards, Insurance, Physician Services, Logistic Models, Multivariate Analysis, Physician's Practice Patterns, Physician-Patient Relations, Questionnaires

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      Abstract

      Ethically, physicians should discuss all medically appropriate services with patients, but coverage restrictions can make these discussions difficult. In a national survey of physicians, we asked how often physicians elected not to offer their patients useful services because of health plan coverage rules. During the course of a year, 31 percent reported having sometimes not offered their patients useful services because of perceived coverage restrictions. Among these, 35 percent reported doing so more often in the most recent year than they did five years ago. It can be frustrating for doctors to discuss uncovered services with their patients, but open communication is necessary for shared decision making and to improve coverage decisions.

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      12889768

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