Primary care physicians give in to patient demands for unnecessary care

By Aine Cryts

Driven by patient demand, 52 percent of primary care physicians admit to making unnecessary referrals to specialists. Thirty-nine percent of physicians yielded to patients asking for brand-name drugs, even when less expensive generics were available, according to a new study published in American Journal of Managed Care.

The results are derived from data on 840 primary care physicians, and help explain why 30 percent of healthcare provided in the United States is believed to be unnecessary, noted the authors.

"Health policy makers also need to explore and implement patient-level incentives to effectively manage requests for unnecessary care, wrote Sapna Kaul, Ph.D., lead author and assistant professor of health economics in the department of preventative medicine and community health at the University of Texas Medical Branch at Galveston. "Consumer-directed competition can increase price sensitivity, create a system of value-seeking patients and contain rising unnecessary spending."

Some additional findings include:

  • It's unclear that meeting with drug and device manufacturer sales representatives had a direct impact on physicians' prescribing behavior
  • Physicians in solo or two-physician practices were more likely to prescribe brand-name drugs than those working at larger practices, possibly to avoid conflicts with patients
  • Older physicians and physicians in smaller practices didn't embrace their role of helping to avoid unnecessary medical care to the same degree as physicians practicing in other settings

Educating patients about the cost of care can help. An affordability tool developed by the Colorado Permanente Medical Group--rolled out to three Denver clinics in 2013--provides physicians with a breakdown of his or her patient panel's insurance profile, the categories of patient expense, the total annual expenditure per member per month, hospital utilization and cost information and benchmarks comparing physicians to regional practices.

To learn more:
- read the American Journal of Managed Care article