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J Gen Intern Med. 2008 Oct;23(10):1595-601. doi: 10.1007/s11606-008-0714-x. Epub 2008 Jul 16.

The impact of consumer-directed health plans and patient socioeconomic status on physician recommendations for colorectal cancer screening.

Author information

  • 1The Robert Wood Johnson Clinical Scholars Program, University of Pennsylvania, Philadelphia, PA 19104, USA. craige@mail.med.upenn.edu

Abstract

BACKGROUND:

Consumer-directed health plans are increasingly common, yet little is known about their impact on physician decision-making and preventive service use.

OBJECTIVE:

To determine how patients' deductible levels and socioeconomic status may affect primary care physicians' recommendations for colorectal cancer screening.

DESIGN, SETTING, AND PARTICIPANTS:

Screening recommendations were elicited using hypothetical vignettes from a national sample of 1,500 primary care physicians. Physicians were randomized to one of four vignettes describing a patient with either low or high socioeconomic status (SES) and either low- or high-deductible plan. Bivariate and multivariate analyses were used to examine how recommendations varied as a function of SES and deductible.

OUTCOME MEASURES:

Rates of recommendation for home fecal occult blood testing, sigmoidoscopy, colonoscopy, and inappropriate screening, defined as no screening or office-based fecal occult blood testing.

RESULTS:

A total of 528 (49%) eligible physicians responded. Overall, 7.2% of physicians recommended inappropriate screening; 3.2% of patients with high SES in low-deductible plans received inappropriate screening recommendations and 11.4% of patients with low SES in high-deductible plans for an adjusted odds ratio of 0.22 (0.05-0.89). The odds of a colonoscopy recommendation were over ten times higher (AOR 11.46, 5.26-24.94) for patients with high SES in low-deductible plans compared to patients with low SES in high-deductible plans. Funds in medical savings accounts eliminated differences in inappropriate screening recommendations.

CONCLUSIONS:

Patient SES and deductible-level affect physician recommendations for preventive care. Coverage of preventive services and funds in medical savings accounts may help to mitigate the impact of high-deductibles and SES on inappropriate recommendations.

PMID:
18629590
[PubMed - indexed for MEDLINE]
PMCID:
PMC2533392
Free PMC Article

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