Do physicians not offer useful services because of coverage restrictions?

Full Abstract

Ethically, physicians should discuss all medically appropriate services with patients, but coverage restrictions can make these discussions difficult. In a national survey of physicians, we asked how often physicians elected not to offer their patients useful services because of health plan coverage rules. During the course of a year, 31 percent reported having sometimes not offered their patients useful services because of perceived coverage restrictions. Among these, 35 percent reported doing so more often in the most recent year than they did five years ago. It can be frustrating for doctors to discuss uncovered services with their patients, but open communication is necessary for shared decision making and to improve coverage decisions.

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Author information

Author/s: Wynia, Matthew K (MK); VanGeest, Jonathan B (JB); Cummins, Deborah S (DS); Wilson, Ira B (IB);

Affiliation: Institute for Ethics, American Medical Association, Chicago, USA.

Journal and publication information

Publication Type: Journal Article

Journal: Health affairs (Project Hope) (Health Aff (Millwood)), published in United States. (Language: eng)

Reference: -2003 Jul-Aug; vol 22 (issue 4) : pp 190-7

Dates: Created 2003/07/31; Completed 2003/08/20; Revised 2004/11/17;

PMID: 12889768, status: MEDLINE (last retrieval date: 12/26/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

Comments and Corrections

CommentIn: Health Aff (Millwood). 2003 Nov-Dec;22(6):283; author reply 284. (PMID: 14649458)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

American Medical Association
Attitude of Health Personnel
Communication
Decision Making
Ethics, Medical
Health Care Surveys
Health Services Accessibility - economics; ethics
Humans

Insurance Coverage - standards
Insurance, Physician Services - standards
Logistic Models
Multivariate Analysis
Physician's Practice Patterns - ethics
Physician-Patient Relations - ethics
Questionnaires
United States

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