title: When the patient does not pay: a survey of primary care physicians.
abstract: OBJECTIVE
  Despite ethical implications, there are anecdotal reports of health practitioners withholding services from patients who do not pay their bills. We surveyed physicians about their attitudes and experiences regarding nonpaying patients.
  
  
  METHODS
  A cross-sectional mailed survey.
  
  
  METHODS
  Three hundred seventy-nine of 1000 surveyed primary care physicians participated.
  
  
  RESULTS
  We studied how likely participants were to withhold 13 services from hypothetical patients who did not pay the physician's bills based on a 4-point Likert scale. Respondents were asked whether they had actually ever withheld such services from patients. The effects of demographic data on the number of services withheld from hypothetical and actual patients were analyzed by analysis of variance and multiple logistic regression. Most respondents (84%) would have withheld at least 1 item of service from the hypothetical patient, with 41% having ever withheld care from their actual patients. Most services involved administrative actions, but many respondents would be willing to forego other types of medical care. Being younger (P = 0.003), believing that patients are not always entitled to medical care (P = 0.002) and being in an urban practice (P = 0.03) were associated with withholding medical care from patients.
  
  
  CONCLUSIONS
  A majority of primary care practitioners responding to our survey would be willing to withhold medical care from patients who do not pay their bills; some have actually done so despite ethical and legal mandates to the contrary. Physicians should be educated about the importance of the patient-physician relationship and their ethical obligations to patients.
authors.affiliation: Department of Medicine, University of California-San Diego, 9350 Campus Point Drive, La Jolla, CA 92037, USA. nfarber@ucsd.edu
authors.forename: Neil J
authors.initials: NJ
authors.lastname: Farber
authors.forename: Charles V
authors.initials: CV
authors.lastname: Roche
authors.forename: Brian M
authors.initials: BM
authors.lastname: Aboff
authors.forename: Virginia U
authors.initials: VU
authors.lastname: Collier
authors.forename: Joan
authors.initials: J
authors.lastname: Weiner
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D004992:Ethics, Medical; D005194:Family Practice / Q000191:economics* / Q000941:ethics / Q000706:statistics & numerical data*; D005251:Fees, Medical / Q000941:ethics / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D011159:Population Surveillance; D010818:Practice Patterns, Physicians' / Q000941:ethics / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000191:economics / Q000941:ethics / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D016079:Refusal to Treat / Q000941:ethics / Q000706:statistics & numerical data*; D017664:Uncompensated Care / Q000191:economics / Q000941:ethics / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology