The influence of resource pressure on medical treatment decisions

Two studies in Florida show that pressure from hospitals and insurance companies to minimize health care costs can negatively affect the quality of care for some people.

Human factors/ergonomics researchers compared medical treatments for incarcerated and unincarcerated (paying) patients and found a startling difference. Findings from the second study will be presented on Wednesday, October 18, 2006, during the HFES 50th Annual Meeting at the Hilton San Francisco Hotel. The meeting dates are October 16-20.

U.S. health care costs are increasing faster than inflation and are estimated to reach 20% of GDP in less than 10 years. Insurance companies and hospitals have created new medical plans and promote self-care technology in hopes of minimizing costs, but doctors resist this rationing system. Nevertheless, economic pressure is shown to have sometimes unconscious effects on physicians' provision of care.

In Study 1, residents and fellows at a major urban hospital provided 50 incarcerated and free diabetes patients with medical treatment based on standards set by the American Medical Association and the American Dental Association. Both groups of patients should have received identical time, attention, and care.

The researchers found that incarcerated patients received significantly less care than free patients. For example, no incarcerated patients received a flu shot or cholesterol screening, but all the free patients did. In Study 2, a random sample of 100 doctors completed a questionnaire, and some were interviewed in more detail about their responses.

When asked what affected their treatment decisions, both the first-year and more experienced residents cited significant financial pressure to cut costs, the correctional status of the patient, obstacles in treating incarcerated patients (for example, shackles and guards), demographics such as socioeconomic status, and assumptions that patients from lower socioeconomic levels and those in prison would be less likely to comply with posttreatment medical care.

Whether conscious or not, some decision-making bias was evident in the provision of care. Paying patients were more likely to be given priority. Explicit bias was identified with regard to both low-income and incarcerated patients whom the doctors assumed were more likely to ignore medical advice.

The researchers suggest that the creation of standard protocols (including patient scheduling), decision support systems, training regimens, and decision support interventions could help to prevent bias and prioritizing in patient care.