Abstract
IntroductionPhysicians vary in their moral judgments about health care costs. Social intuitionism posits that moral judgments arise from gut instincts, called “moral foundations.” The objective of this study was to determine if “harm” and “fairness” intuitions can explain physicians’ judgments about cost-containment in U.S. health care and using cost-effectiveness data in practice, as well as the relative importance of those intuitions compared to “purity”, “authority” and “ingroup” in cost-related judgments.MethodsWe mailed an 8-page survey to a random sample of 2000 practicing U.S. physicians. The survey included the MFQ30 and items assessing agreement/disagreement with cost-containment and degree of objection to using cost-effectiveness data to guide care. We used t-tests for pairwise subscale mean comparisons and logistic regression to assess associations with agreement with cost-containment and objection to using cost-effectiveness analysis to guide care.Results1032 of 1895 physicians (54%) responded. Most (67%) supported cost-containment, while 54% expressed a strong or moderate objection to the use of cost-effectiveness data in clinical decisions. Physicians who strongly objected to the use of cost-effectiveness data had similar scores in all five of the foundations (all p-values > 0.05). Agreement with cost-containment was associated with higher mean “harm” (3.6) and “fairness” (3.5) intuitions compared to “in-group” (2.8), “authority” (3.0), and “purity” (2.4) (p < 0.05). In multivariate models adjusted for age, sex, region, and specialty, both “harm” and “fairness” were significantly associated with judgments about cost-containment (OR = 1.2 [1.0-1.5]; OR = 1.7 [1.4-2.1], respectively) but were not associated with degree of objection to cost-effectiveness (OR = 1.2 [1.0-1.4]; OR = 0.9 [0.7-1.0]).ConclusionsMoral intuitions shed light on variation in physician judgments about cost issues in health care.
Highlights
Physicians vary in their moral judgments about health care costs
Amid discussions on how to implement Comparative effectiveness research (CER), prominent professional societies such as the American College of Physicians have called for comparative effectiveness research to include costeffectiveness analysis [5]
This study examines whether a social intuitionist theoretical framework may explain differences in physicians’ judgments about using cost-effectiveness data to guide clinical decisions as well as their judgments about other cost-containment strategies
Summary
Physicians vary in their moral judgments about health care costs. Comparative effectiveness research (CER), as defined by the Agency for Healthcare Research and Quality, “is designed to inform health-care decisions by providing evidence on the effectiveness, benefits, and harms of different treatment options [4]. Amid discussions on how to implement CER, prominent professional societies such as the American College of Physicians have called for comparative effectiveness research to include costeffectiveness analysis [5]. In 1996, the U.S Panel on Cost-Effectiveness in Health and Medicine proposed that cost-effectiveness analyses should use quality-adjusted life-years (QALYs) to assign value to health care outcomes [6]. Critics have argued that current proposals for using cost-effectiveness analysis go too far and become veiled attempts to ration health care by cutting provider reimbursements [7]
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