title: Primary care physicians' perceptions of the effect of insurance status on clinical decision making.
abstract: OBJECTIVE
  Americans who do not have health insurance receive fewer health services and have poorer health status than those who have insurance. To better understand this disparity, in this study we characterize primary care physician's perceptions of what effect, if any, patients' insurance status has on their clinical decision making during office visits.
  
  
  METHODS
  Twenty-five physician members of CAPRICORN, a primary care practice-based research network in metropolitan Washington, DC, completed a brief paper-card survey instrument immediately after each patient encounter during 2 half-day office sessions. Participants saw patients in their usual manner and were given no additional information about their patients or their insurance.
  
  
  RESULTS
  Eighty-eight percent of participating physicians reported making at least 1 change in clinical management as a result of a patient's insurance status. They reported altering their management during 99 of 409 patient encounters (24.2%). There was a significant difference in the percentage of visits that involved a change in management for privately insured, publicly insured, and uninsured patients (18.7%, 29.5%, and 43.5% respectively, P = .01). Physicians reported discussing insurance issues with patients during 62.6% of visits during which they made a change in management based on insurance status.
  
  
  CONCLUSIONS
  Physicians incorporate their patients' insurance status into their clinical decision making and acknowledge they frequently alter their clinical management as a result. Additional research is needed to understand the effect of these changes on patient health and to assist both physicians and patients in enhancing the quality of care delivered within the constraints of the current insurance system.
authors.affiliation: Capital Area Primary Care Research Network, Georgetown University Medical Center, Washington, DC, USA. dmeyers@ahrq.gov
authors.forename: David S
authors.initials: DS
authors.lastname: Meyers
authors.forename: Ranit
authors.initials: R
authors.lastname: Mishori
authors.forename: Jessica
authors.initials: J
authors.lastname: McCann
authors.forename: Jose
authors.initials: J
authors.lastname: Delgado
authors.forename: Ann S
authors.initials: AS
authors.lastname: O'Malley
authors.forename: Ed
authors.initials: E
authors.lastname: Fryer
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003657:Decision Making; D004219:District of Columbia; D005194:Family Practice / Q000191:economics* / Q000592:standards; D005260:Female; D006302:Health Services Research; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health / Q000191:economics; D008297:Male; D015999:Multivariate Analysis; D009819:Office Visits; D010865:Pilot Projects; D011320:Primary Health Care / Q000191:economics* / Q000592:standards