title: The impact of financial incentives on physician empathy: a study from the perspective of patients with private and statutory health insurance.
abstract: OBJECTIVE
  We hypothesized that patients' ratings of physician empathy (PE) would be higher among those with private health insurance (PHI, referring to financial incentive) than among patients with statutory health insurance (SHI).
  
  
  METHODS
  A postal survey was administered to 710 cancer patients. PE was assessed using the Consultation-and-Relational-Empathy measure. T-tests were conducted to analyse whether PHI and SHI-patients differ in their ratings of PE and variables relating to contact time with the physician. Structural-equation-modelling (SEM) verified mediating effects.
  
  
  RESULTS
  PHI-patients rated physician empathy higher. SEM revealed that PHI-status has a strong significant effect on frequency of talking with the physician, which has a strong significant effect (1) on PE and (2) has a moderate effect on patients' perception of medical staff stress, thereby also affecting patients' ratings of PE.
  
  
  CONCLUSIONS
  Our findings suggest that PHI-status is one necessary precondition for physicians spending more time with the patient. Spending more time with the PHI-patient has two major effects: it results in a more positive perception of PE and positively impacts PHI-patients' perception of medical staff stress, which in turn, again influences PE.
  
  
  CONCLUSIONS
  Health policy should discuss these findings in terms of equality in receiving high-quality care.
authors: Gerhard Kienle Chair for Medical Theory, Integrative and Anthroposophic Medicine, Integrated Curriculum for Anthroposophic Medicine, Faculty for Health, Private University of Witten/Herdecke, Germany. melanie.neumann@uni-wh.de
authors: Melanie
authors: M
authors: Neumann
authors: Jozien
authors: J
authors: Bensing
authors: Markus
authors: M
authors: Wirtz
authors: Ansgar
authors: A
authors: Wübker
authors: Christian
authors: C
authors: Scheffer
authors: Diethard
authors: D
authors: Tauschel
authors: Friedrich
authors: F
authors: Edelhäuser
authors: Nicole
authors: N
authors: Ernstmann
authors: Holger
authors: H
authors: Pfaff
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002204:Capitation Fee; D003142:Communication; D004645:Empathy; D005163:Factor Analysis, Statistical; D018588:Fee-for-Service Plans; D005260:Female; D005382:Financing, Personal; D006291:Health Policy; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health; D008297:Male; D009042:Motivation; D009369:Neoplasms / Q000628:therapy; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology; D017149:Private Sector; D011795:Surveys and Questionnaires