- The Washington Times - Monday, July 7, 2003


Nearly 1 in 3 doctors reports withholding information from patients about useful medical services that aren’t covered by their health insurance companies, and the number may be on the rise, a study reports.

Study authors say their work offers the first empirical evidence for what many have long suspected: that coverage limitations imposed by managed care are infiltrating doctor-patient communications.

“Patients aren’t getting the whole story,” said Matthew K. Wynia, director of the Institute for Ethics at the American Medical Association and lead author of the article being published in the journal Health Affairs.

Mr. Wynia and his colleagues surveyed 700 physicians and asked how often they had decided not to offer a “useful service to a patient because of health-plan rules.” Forty-two percent said never, and 27 percent said rarely.

But 23 percent said, “sometimes,” and 8 percent said, “often” or “very often.”

The results hearken to several years ago, when some managed care companies barred doctors from discussing medical options not covered by the health plan. Public outcry persuaded most companies to drop those rules, known as “gag clauses,” and many states banned them from contracts.

The study found that doctors whose salaries are closely tied to controlling costs were more likely than other doctors to report withholding information.

In addition, those who serve a large number of Medicaid patients were more likely to stay silent, as were those who said they believed patients might want them to deceive their insurance companies to get services covered.

Authors note an important caveat: The term “useful service” was not defined in the survey. To one doctor that could mean steering a patient to a generic drug, rather than the more expensive brand-name version, while to another it could mean not mentioning a major surgical procedure.

The most positive interpretation of the study’s results would be that doctors are withholding information on services that might be useful, but are less clearly necessary than others, said Dr. Hoangmai Pham, senior health researcher at the Center for Studying Health System Change, who was not part of the research team.

The most negative interpretation, she said, is that doctors have been conditioned to withhold information, shortchanging patients.

All of it can be compounded by time pressures, Dr. Pham said: Doctors with a limited amount of time with a patient may not spend it talking about services that the patient has no way to pay for.

“It’s simply not possible to discuss everything with every patient,” she said. “You might go down your list of three or five top options, but not discuss every last one.”

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