Relationship Between Primary Care Physicians’ Cost Profiles and Patient Satisfaction in a Central Florida Employer Health Plan
The Problem
While researchers have extensively studied physician profiling and patient satisfaction, there is a lack of scientific inquiry into the relationship between physician cost profiles (i.e., high cost or low cost) and patient satisfaction survey results.
Rationale for the Study
This lack of information is a serious problem for an effective health care system, because it leads to counterproductive decisions. For example, there are many incentive programs that reward physicians for low costs and high patient satisfaction, yet there is insufficient information on whether these incentives work—or worse, whether these incentives negatively affect the physician-patient relationship.
Research Question
The specific research question addressed was whether there is a relationship between primary care physician cost profiles and patient satisfaction.
Data Source
The analysis was based on archival data obtained from the health plan of a large public sector employer in central Florida.
Methodology
Primary care physician cost profiles were constructed from health care claims data. Patient satisfaction scores were obtained from a patient satisfaction survey. Regression analysis was used to test the relationship between the cost profile dimensions and the patient satisfaction dimensions.
Cost profile dimensions included primary care physician costs, non-primary care physician costs, facility costs, and medication costs.
Patient satisfaction dimensions included satisfaction with access, care, wellness, and overall satisfaction.
Results
The results showed significant correlation between (a) medication costs and patient satisfaction at the 0.01 level for all patient satisfaction dimensions, and (b) primary care physician costs and patient satisfaction at the 0.01 level for all patient satisfaction dimensions except access. Patients are more satisfied when the cost profile is higher.
Discussion
These findings are contrary to physician incentive programs that reward physicians for low costs and high patient satisfaction. The results also provide further insights into the problems experienced by physicians trying to represent both the patient and the payer. Insurance companies prefer low costs, but patients prefer high costs.
Social Change Perspective
From a social change perspective, these results suggest a series of ideas to explore.
Alternate incentive programs may lessen the tension in the physician-patient relationship, leading to better patient compliance and improved outcomes.
Policy-makers may further examine the relationship between direct-to-consumer (DTC) pharmaceutical advertisement and patients’ demands for specific prescription medication. DTC shapes patient expectations for particular medications; if the physician does not meet these expectations, patients are dissatisfied.
Further, policy-makers may initiate a discussion about the focus of the U.S. health care system. This discussion may lead to a shift in the focus from an acute care model to a wellness model.
A wellness model may result in educational programs for patients to shift their definition of satisfaction from quantity to quality, regulatory intervention to prevent inappropriate incentive schemes from insurers, and a revised physician education model. Stakeholders in the health care system will benefit from lower costs, better treatment outcomes, and improved health.
Dr. Markus Mueller holds a Ph.D. in Applied Management and Decision Sciences from Walden University and an M.B.A. from the University of North Florida; he is a graduate of Harvard University’s Special Studies in Management and Administration program. This research is based on his dissertation. Mueller is the owner of an international management consulting firm with a primary focus on the health care industry. His clients include health insurance companies, physician groups, hospitals, and administrators in the United States and Europe. He can be reached at fcmuellerch@yahoo.com.
