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CMAJ. Jan 27, 1998; 158(2): 197–202.
PMCID: PMC1232692

What factors influence primary care physicians' charges for their services? An exploratory study using standardized patients


OBJECTIVE: To determine the extent of variation in physicians' charges for health care encounters with unannounced standardized patients and factors associated with the variation. DESIGN: Cross-sectional study. SETTING: Family practices open to new patients within 1 hour's drive of Hamilton, Ont. PARTICIPANTS: A stratified random sample of 125 physicians who had responded to an earlier survey regarding preventive care were invited to participate. Of the 125, 44 (35.2%) declined to participate, and an additional 19 (15.2%) initially consented but later withdrew because they closed their practices to new patients. Sixty-two physicians thus participated in the study. INTERVENTION: Unannounced standardized patients posing as new patients to the practice visited study physicians' practices between September 1994 and August 1995, portraying 4 scenarios: 28-year-old woman, 52-year-old woman, 48-year-old man and 70-year-old man. OUTCOME MEASURES: Physician characteristics, encounter characteristics and charges made for services. RESULTS: The 62 physicians had 246 encounters with the standardized patients. Charges were made to the health insurance plan for services by 59 physicians for up to 4 encounters (215 encounters in all). Charges varied considerably both within and across patient scenarios. Time spent with the patient was an important factor predicting charges made (p < 0.01), although the effect of time spent on charges varied across scenarios (p < 0.01). Fee-for-service physicians charged more for their services than physicians who usually had alternative billing arrangements (p < 0.01). Female physicians charged more for their services than their male colleagues (p = 0.03). No relation was found between quality of preventive care and charges made (p = 0.15). CONCLUSIONS: Physician-related factors are better able to account for the variability in charges for their services than patient-related factors. Physicians seeing comparable patients may earn much more or less than their colleagues because of differences in the services they provide and the way they apply the fee schedule. Quality-assurance techniques are likely needed to reduce the variability in charges seen and increase value for money spent in health care.

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Selected References

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  • Owen A, Winkler R. General practitioners and psychosocial problems: An evaluation using pseudopatients. Med J Aust. 1974 Sep 14;2(11):393–398. [PubMed]
  • Renaud M, Beauchemin J, Lalonde C, Poirier H, Berthiaume S. Practice settings and prescribing profiles: the simulation of tension headaches to general practitioners working in different practice settings in the Montreal area. Am J Public Health. 1980 Oct;70(10):1068–1073. [PMC free article] [PubMed]
  • Woodward CA, McConvey GA, Neufeld V, Norman GR, Walsh A. Measurement of physician performance by standardized patients. Refining techniques for undetected entry in physicians' offices. Med Care. 1985 Aug;23(8):1019–1027. [PubMed]
  • Norman GR, Neufeld VR, Walsh A, Woodward CA, McConvey GA. Measuring physicians' performances by using simulated patients. J Med Educ. 1985 Dec;60(12):925–934. [PubMed]
  • Russell NK, Boekeloo BO, Rafi IZ, Rabin DL. Using unannounced simulated patients to evaluate sexual risk assessment and risk reduction skills of practicing physicians. Acad Med. 1991 Sep;66(9 Suppl):S37–S39. [PubMed]
  • Hazelkorn HM, Macek MD. Perception of the need for removal of impacted third molars by general dentists and oral and maxillofacial surgeons. J Oral Maxillofac Surg. 1994 Jul;52(7):681–687. [PubMed]
  • Hazelkorn HM. A comparison of dental treatment plans under different reimbursement systems. J Public Health Policy. 1985 Jun;6(2):223–235. [PubMed]
  • Carney PA, Dietrich AJ, Freeman DH, Jr, Mott LA. The periodic health examination provided to asymptomatic older women: an assessment using standardized patients. Ann Intern Med. 1993 Jul 15;119(2):129–135. [PubMed]
  • Wennberg JE, Freeman JL, Culp WJ. Are hospital services rationed in New Haven or over-utilised in Boston? Lancet. 1987 May 23;1(8543):1185–1189. [PubMed]
  • Langwell KM. Factors affecting the incomes of men and women physicians: further explorations. J Hum Resour. 1982 Spring;17(2):261–275. [PubMed]
  • Woodward CA, Hurley J. Comparison of activity level and service intensity of male and female physicians in five fields of medicine in Ontario. CMAJ. 1995 Oct 15;153(8):1097–1106. [PMC free article] [PubMed]
  • Bertakis KD, Helms LJ, Callahan EJ, Azari R, Robbins JA. The influence of gender on physician practice style. Med Care. 1995 Apr;33(4):407–416. [PubMed]

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