A July 8, 2003 Associated Press story that appeared on the MSN and the InteliHealth websites reported on a study showing that doctors withhold offering health care choices to their patients based on the types of insurance coverage they have. The study shows that nearly one in three doctors reports withholding information from patients about useful medical services that aren’t covered by their health insurance companies. The authors of the study say their work offers the first solid evidence that coverage limitations imposed by managed care is having a profound effect on doctor-patient recommendations.
Matthew K. Wynia, director of the Institute for Ethics at the American Medical Association and lead author of the article being published in the journal Health Affairs says, “Patients aren’t getting the whole story”. Wynia and his colleagues surveyed 700 physicians and asked how often they had decided not to offer a “useful service to a patient because of health plan rules.” The results of the survey, which was conducted in 1998 and 1999, were analyzed in the July 9, 2003 edition of the medical journal “Health Affairs.” The results showed 42 percent said never, and 27 percent said rarely. But surprisingly, 23 percent said “sometimes,” and 8 percent said “often” or “very often.”
The articles noted that while ethics codes require doctors to disclose “medically appropriate treatment alternatives, regardless of cost, a lot of doctors are nervous about describing medically indicated … care that isn’t covered” by insurance. William S. Custer, a professor in the Insurance Department at Georgia State University, said doctors have always factored a patient’s ability to afford treatment into their medical advice. He notes, “Doctors have done that since the days of Marcus Welby. They understood what the patient could afford and offered services that would fit what they could afford.”
Several years ago, some managed care companies barred doctors from discussing medical options not covered by the health plan. Those rules, known as “gag clauses,” were abandoned by most companies because of public outcry. Additionally, many states passed laws banning gag clauses from insurance policies and contracts.