title: Financial incentives and physicians' perceptions of conflict of interest and ability to arrange medically necessary services.
abstract: Many believe that physician payment mechanisms that include incentives to restrain utilization create conflicts of interest for physicians and result in the withholding of needed services. Pooled data from two rounds of the Community Tracking Study physician survey, a nationally representative telephone survey of physicians, are the basis of this analysis. We examine the association between explicit financial incentives linked to physician profiling and perceived conflict of interest, and the reported ability to obtain specific, medically necessary secondary services (referrals, hospitalizations and diagnostic imaging). Logistic regression models were employed to control for potentially confounding influences. After controlling for other factors, physicians subject to profiling linked with financial incentives were much less likely than physicians not affected by profiling to strongly agree that they can make clinical decisions in the best interests of their patients without the possibility of reducing their income. They were also less likely to report that they could always obtain selected medically necessary secondary services for their patients. Physicians subject to explicit financial incentives based on profiling are more likely than other physicians to perceive a conflict of interest. Physicians with financial incentives tied to profiling also experience greater difficulty obtaining medically necessary secondary services for their patients.
authors.affiliation: Center for Studying Health System Change, 600 Maryland Avenue, SW, Suite 550, Washington, DC 20024-2512, USA.
authors.forename: Jeffrey J
authors.initials: JJ
authors.lastname: Stoddard
authors.forename: Marie
authors.initials: M
authors.lastname: Reed
authors.forename: Jack
authors.initials: J
authors.lastname: Hadley
mesh_terms: D001291:Attitude of Health Personnel; D016265:Conflict of Interest; D003657:Decision Making; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D016015:Logistic Models; D010816:Physician Incentive Plans / Q000191:economics*; D010820:Physicians / Q000145:classification / Q000191:economics / Q000523:psychology*; D010818:Practice Patterns, Physicians' / Q000191:economics*; D017009:Professional Autonomy; D014481:United States