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The Effect of Physician Disclosure of Financial Incentives on Trust
Wendy Levinson, MD;
Audiey Kao, MD, PhD;
Alma M. Kuby, MBA;
Ronald A. Thisted, PhD
Arch Intern Med. 2005;165:625-630.
Background Many physicians receive financial incentives to limit their ordering of expensive tests and procedures. While Medicare mandates disclosure of incentives, it is not clear how to inform patients without undermining trust.
Methods Our objective was to determine public opinion about physician disclosure of financial incentives and how this might be best communicated to patients. The 2002 General Social Survey included 2765 interviews from a probability sample of English-speaking US households. The interview included questions about financial incentives and an audiotaped scenario of a physician discussing the impact of financial incentives on ordering a magnetic resonance image. Respondents heard 1 of 6 randomly selected disclosure strategies. The measurements included ratings of trust, satisfaction, agreement with the physician’s decision, and likelihood of remaining with the physician/health plan or seeking a second opinion.
Results Nearly half (48.8%) of respondents had previously heard of financial incentives to limit test ordering. Of the respondents, 94.8% wanted to be told about incentives, at the time of enrollment in a health plan (80.5%), by a health plan representative (44.8%), their physician (17.1%), or both (38.1%). Of the 6 different disclosure strategies, "addressing emotions" and "negotiation" were associated with the best outcomes, while "common enemy" and "denying influences" were most negatively perceived. Black and Hispanic subjects were less likely to express satisfaction or trust and more likely to disenroll or seek a second opinion.
Conclusions The public wants information about physician financial incentives. Specific communication styles enhance how this information is conveyed to patients, increasing trust and supporting the physician-patient relationship.
Author Affiliations: Department of Medicine, University of Toronto,St Michael’s Hospital, Toronto, Ontario (Dr Levinson); Ethics Standards Group, American Medical Association, Chicago, Ill (Dr Kao); and National Opinion Research Center (Ms Kuby) and Department of Health Studies (Dr Thisted), The University of Chicago, Chicago.
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