NCPA - National Center for Policy Analysis

Patients Aren't Getting the Whole Story

July 9, 2003

Nearly 1 in 3 doctors reports withholding information from patients about useful medical services that aren't covered by their health insurance companies, and the number may be on the rise, according to a new study in the journal Health Affairs.

The authors say their work offers the first empirical evidence for what many have long suspected: that coverage limitations imposed by managed care are infiltrating doctor-patient communications.

Surveying 700 physicians, the authors asked how often each had decided not to offer a "useful service to a patient because of health-plan rules."

  • Forty-two percent said never, and 27 percent said rarely.
  • Some 23 percent said, "sometimes."
  • While nearly 8 percent said, "often" or "very often."

The results hearken to several years ago, when some managed care companies barred doctors from discussing medical options not covered by the health plan. Public outcry persuaded most companies to drop those rules, known as "gag clauses," and many states banned them from contracts.

The study found that doctors whose salaries are closely tied to controlling costs were more likely than other doctors to report withholding information.

In addition, those who serve a large number of Medicaid patients were more likely to stay silent, as were those who said they believed patients might want them to deceive their insurance companies to get services covered.

Source: Associated Press, "Doctors Withholding Information, Study Finds," Washington Times, July 8, 2003.


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