Who’s responsible for controlling health care costs?

That’s the question that a recent study in JAMA asked doctors. “Views of US Physicians About Controlling Health Care Costs“:

Importance  Physicians’ views about health care costs are germane to pending policy reforms.

Objective  To assess physicians’ attitudes toward and perceived role in addressing health care costs.

Design, Setting, and Participants  A cross-sectional survey mailed in 2012 to 3897 US physicians randomly selected from the AMA Masterfile.

Main Outcomes and Measures  Enthusiasm for 17 cost-containment strategies and agreement with an 11-measure cost-consciousness scale.

So who do docs think is responsible? Evidently, everyone but them. Those who have a “major” responsibility for lowering health care costs included trial lawyers (60%), insurance companies (59%), hospitals and health systems (56%), drug and device companies(56%), and, of course,  patients (52%). Only about a third of them thought they they themselves has a “major” responsibility. Lots of them approve of quality initiatives to reduce cost, but almost none (7%) thought that getting rid of fee-for-service reimbursement was a good idea.

Ezekiel Emanuel and Andrew Steinmetz, who wrote an editorial on this study, noted something important:

These attitudes, however, have an interesting character: while supporting cost-consciousness in health care, they largely relieve the physician from being the decision-maker and taking responsibility for cost control. Someone outside—either insurance companies, a government board, or some organization determining cost-effectiveness ratios—would bear the responsibility for bringing cost into the health care equation. This would allow physicians to point to someone else doing the resource allocation and cost control.

One of the reasons I’ve often supported “more” government involvement is that someone has to be the “bad guy” at some point. Physicians, amongst others, often don’t want to do that. But sometimes, someone has to say “no”.

Both the study and the editorial are worth your time.


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