Risk Aversion and Costs A Comparison of Family Physicians and General Internists

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Original Research

Risk Aversion and Costs A Comparison of Family Physicians and General Internists

J Fam Pract. 2000 January;49(1):12-17

References

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Limitations

Our study has several limitations. First, we did not address the question of whether specialty differences in costs or risk aversion were associated with differences in patient outcomes. Second, our study was conducted in a community where there had been an emphasis on the biopsychosocial model among both internists and family physicians.³³ It is not clear how this tradition might affect the generalizability of these findings to other communities. Third, the specialty difference in expenditures both before and after adjustment for risk aversion was modest. This small difference reflects, in part, the contradictory findings previously reported in the literature.^1-8 Fourth, it is possible that differences in case mix between specialties not fully captured through ambulatory diagnostic groups explain the observed differences between specialties. Other unmeasured patient factors could also account for our findings. For example, patients who are more risk averse and desire more health care may seek physicians with a similar psychological orientation. Finally, it is possible that response bias accounted for these findings. Slightly less than two thirds of the physicians submitted fully completed surveys. If family physicians with lower costs responded disproportionately to internists with lower costs, then response bias would produce a spurious relationship between specialty and costs. However, an analysis that included both completion of the survey as a variable and the interaction of that variable with specialty revealed that neither completion of the survey nor the interaction effects were statistically significant. A similar potential bias exists for risk aversion; this, however, could not be examined.

Conclusions

We found that the family physicians compared had significantly lower total adjusted medical expenditures than general internists for managed care patients. These differences were no longer statistically significant after adjustment for specialty differences in risk aversion. Further study is needed to determine the origin of these specialty differences and whether those differences affect patient outcomes.

Acknowledgments

This study was supported by grant R01 HS09397-01 from the Agency for Health Care Policy and Research.