Surveying the Cost Decisions of Physicians

The Visible Fairness project has been gathering data on physicians in preparation for its next phase: developing and conducting discussion groups with the public.

In early June, those physicians-approximately one-third of all physicians in the region-received that survey by mail. I was one of them and completed the survey promptly. I hope my 999 colleagues did so as well.

This survey is part of a local project called Visible Fairness, an 18-month, multi-organizational effort to learn how the public views the concept of cost-benefit trade-offs in medical practice and coverage decisions.

Funded by the California HealthCare Foundation, Visible Fairness is composed of 15 organizations: consumer groups, purchasers, medical groups and health plans, including the Sacramento-El Dorado Medical Society. It was organized by Sacramento Healthcare Decisions, a nonprofit, independent organization committed to public participation in health policy issues.

Though this is a local project, it is noteworthy that there are several statewide groups participating, such as CalPERS and AARP. The interest of these major players speaks volumes about the importance of this subject.

Most physicians today would readily acknowledge that society wants far more health care than it is willing to pay for. And though physicians are concerned about this, I think the immediacy of our day-to-day pressures-seeing more patients in less time; the hassle of dealing with multiple health plans; patients' high expectations; declining compensation, among others-can limit our view of health care from a broader perspective. Our world is focused on the series of individual patients who rely on us to provide the best possible care for each of them.

However, our patients also want health care to be affordable for themselves and others. We usually assume that this is a job for "society." Are physicians capable of addressing both needs simultaneously? Do we even want to?

These challenging professional and ethical questions were evident to me as medical director for FPA Medical Group of Northern California, a physician practice management group. Though I have returned to practicing medicine full-time in a 3-person family practice group with Sutter Independent Physicians, the lessons learned as medical director make me take cost-effectiveness seriously.

Interestingly, the primary reason for the physician survey is to prepare Visible Fairness for its next phase: developing and conducting discussion groups with the public. Cost-effectiveness is understood by physicians (even when applied inconsistently), but the public has had little exposure to it.

I applaud the efforts of these 15 organizations to bring this complex and controversial subject out into the open and, in particular, their willingness to work collaboratively. I believe it will take this type of cooperation among disparate groups if we are ever to design a health care system that works for everyone.

For more information on the Visible Fairness project, contact Marge Ginsburg, project director, at (916) 484-2485 or email  marge.shd@quiknet.com