More than half of physicians surveyed in a national study engaged in acts of rationing medicine, according to a study published on July 19th in the Journal of General Internal Medicine. Approximately 53% of physicians personally refrained from offering patients specific services that would have provided the best care because of health system cost.
The two most significant services not provided were prescription drugs (48.3%) and MRIs (44.5%). Other notable care options that were rationed included referral to an intensive care unit (10.9%), referral for surgery (20.2%), and hospital admission (18.8%). Rationing for everything except one category was reported relatively infrequently (monthly), while rationing prescription drugs was reported almost daily. Surgical and procedural specialists were far less likely to report rationing behavior compared with primary care physicians.
Nowhere in the study, however, did the word “rationing” appear – the questions focused on behavior rather than attitudes. It is believed that this was the first study to address physicians’ behavior on rationing medicine.
Smaller, independent practices were more likely to ration medicine than larger organizations. The author put forth several possible explanations, including that they might be “rationing medicine by proxy” to avoid the burden of insurance paperwork, prior authorizations, and out-of-pocket costs for the insured. It’s also possible that independent physicians are less likely to recommend services if they feel their efforts will be in vain or will not be compensated.
An accompanying editorial urges caution in interpreting the results. “Major limitations exist in the way questions were asked and the behavioral definition used to frame questions without directly asking about rationing medicine,” the editorialists wrote. The study also did not address possible motivation for not prescribing certain services. To remove any ambiguity, they suggest that future studies use the actual term “rationing” in the questions, and should include questions that get to the motivation behind the decisions..
