Do physicians not offer useful services because of coverage restrictions?

Health Affairs

Volumn 22, Issue 4, 2003, Pages 190-197

  Wynia, Matthew K ^a   VanGeest, Jonathan B ^b,c   Cummins, Deborah S ^d   Wilson, Ira B ^e  

^a AMERICAN MEDICAL ASSOCIATION   (United States)

^b AMA's Medicine and Public Health Unit

^c AMA's Program on Health Disparities

^d National Patient Safety Foundation   (United States)

^e TUFTS UNIVERSITY SCHOOL OF MEDICINE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CLINICAL PRACTICE; DECISION MAKING; DOCTOR PATIENT RELATION; ECONOMICS; EMPIRICAL APPROACH; EPIDEMIOLOGY; ETHICS; HEALTH CARE AND PUBLIC HEALTH; HEALTH CARE DELIVERY; HEALTH INSURANCE; HEALTH PERSONNEL ATTITUDE; HUMAN; INSURANCE; INTERPERSONAL COMMUNICATION; MEDICAL ETHICS; MEDICAL SOCIETY; MULTIVARIATE ANALYSIS; QUESTIONNAIRE; STANDARD; STATISTICAL MODEL; UNITED STATES;

EMPIRICAL APPROACH; HEALTH CARE AND PUBLIC HEALTH;

AMERICAN MEDICAL ASSOCIATION; ATTITUDE OF HEALTH PERSONNEL; COMMUNICATION; DECISION MAKING; ETHICS, MEDICAL; HEALTH CARE SURVEYS; HEALTH SERVICES ACCESSIBILITY; HUMANS; INSURANCE COVERAGE; INSURANCE, PHYSICIAN SERVICES; LOGISTIC MODELS; MULTIVARIATE ANALYSIS; PHYSICIAN'S PRACTICE PATTERNS; PHYSICIAN-PATIENT RELATIONS; QUESTIONNAIRES; UNITED STATES;

EID: 0042161745     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.22.4.190     Document Type: Article

References (41)

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3. J.A. Buck et al., "Behavioral Health Benefits in Employer-Sponsored Health Plans, 1997," Health Affairs (Mar/Apr 1999): 67-78;
4. and K. Titlow et al., "Drug Coverage Decisions: The Role of Dollars and Values," Health Affairs (Mar/Apr 2000): 240-247.
5. A.M. Garber, "Evidence-Based Coverage Policy," Health Affairs (Sep/Oct 2001): 62-82.
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9. R.M. Werner et al., "The 'Hassle Factor': What Motivates Physicians to Manipulate Reimbursement Rules?" Archives of Internal Medicine 162, no. 10 (2002): 1134-1139;
10. and V.G. Freeman et al., "Lying for Patients: Physician Deception of Third Party Payers," Archives of Internal Medicine 159, no. 19 (1999): 2263-2270.
11. AMA, American Medical Association Code of Medical Ethics, Current Opinions (Chicago: AMA, 2002), 138;
12. Ethics and Human Rights Committee, American College of Physicians-American Society of Internal Medicine, "Ethics Manual, Fourth Edition, American College of Physicians," Annals of Internal Medicine (1 April 1998): 576-594;
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17. AMA, American Medical Association Code of Medical Ethics, Current Opinions, 112-113;
18. and ACP-ASIM, "Ethics Manual."
19. H. Brody and V.L. Bonham, "Gag Rules and Trade Secrets in Managed Care Contracts: Ethical and Legal Concerns," Archives of Internal Medicine 157, no. 18 (1997): 2037-2043;
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21. Wynia et al., "Physician Manipulation";
22. and J.B. VanGeest et al., "Measuring Deception: Test-Retest Reliability of Physicians' Self-Reported Manipulation of Reimbursement Rules for Patients," Medical Care Research and Review 59, no. 2 (2002): 544-549.
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24. and VanGeest et al., "Measuring Deception."
25. Wynia et al., "Physician Manipulation";
26. and VanGeest et al., "Measuring Deception."
27. Tom Pasco, AMA, personal communication, 21 July 1999.
28. See, for example, E.J. Emanuel and L.L. Emanuel, "Four Models of the Physician-Patient Relationship," Journal of the American Medical Association 267, no. 16 (1992): 2221-2226;
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32. AMA, American Medical Association Code of Medical Ethics, 112-113;
33. and ACP-ASIM, "Ethics Manual."
34. P. Lee, quoted in CHCF, Determining Medical Necessity, RT6.
35. G.C. Alexander et al., "Support for Physician Deception of Insurance Companies among a Sample of Philadelphia Residents," Annals of Internal Medicine 138, no. 6 (2003): 472-475.
36. Wynia et al., "Physician Manipulation."
37. S.D. Watson, "Race, Ethnicity, and Quality of Care: Inequalities and Incentives," American Journal of Law and Medicine 27, nos. 2-3 (2001): 203-224.
38. M.G. Bloche, "Race and Discretion in American Medicine," Yale Journal of Health Policy, Law, and Ethics 1, no. 1 (2001): 95-131.
39. Henry J. Kaiser Family Foundation, "Survey of Race, Ethnicity, and Medical Care: Public Perceptions and Experiences," in National Survey of Physicians: Part 1: Doctors on Disparities in Medical Care (Chart Pack) (Menlo Park, Calif.: Kaiser Family Foundation, 2002).
40. S. Felt-Lisk and G.P. Mays, "Back to the Drawing Board: New Directions in Health Plans' Care Management Strategies," Health Affairs (Sep/Oct 2002): 210-217.
41. Brody and Bonham, "Gag Rules and Trade Secrets."