Physicians Report that Health Insurer Practices Harm Patients and Increase Costs by Interfering with Physicians’ Professional Judgement
— Aimed Alliance releases a new survey evaluating primary care physicians’ perceptions of insurance barriers —
Contact: Emily Bloom
Washington, DC; October 29, 2018 – Nine in ten primary care physicians (92 percent) say health insurer staff are not competent to make medical decisions about treatment regimens, according to a new survey from Aimed Alliance. This finding is consistent with recent news reports showing that health insurer personnel neither review medical records nor have underlying familiarity with patients’ health conditions when making benefit determinations. Charting the experiences of 600 physicians practicing family medicine, internal medicine, pediatrics, and obstetrics/gynecology, the survey highlights physicians’ perceptions on the impacts that insurers’ cost containment policies have on patients and physicians alike.
According to the survey, 87 percent of practicing physicians report that health insurers restrict their ability to prescribe individualized treatments, and 79 percent say health insurers have a negative effect on patient care.
“These findings put a spotlight on health insurer practices that interfere with shared decision-making and harm patients,” said Nellie Wild, Aimed Alliance Policy Advisor. “Today, decisions about a course of treatment that were once made by the doctor and patient are being questioned, and often overturned, by health plans to control their costs. The consequences are poorer health outcomes for patients and increased medical costs for the health system, neither of which are acceptable byproducts of cost containment efforts.”
Among other findings, the survey exposes the toll on physicians when they lose their clinical autonomy to health insurers. According to the survey:
- 90 percent of physicians had diminished time for patient care, and 77 percent had to hire extra staff, due to the increased administrative burdens resulting from benefit utilization practices.
- 89 percent say they no longer have adequate influence in making health decisions.
- 47 percent worry patients are losing confidence in the care physicians provide and, in response, almost half (48 percent) are considering getting out of medicine and 67 percent would not recommend a career in medicine to aspiring medical professionals.
“Primary care physicians are on the frontlines in treating American families, and their perspectives on the declining role of physicians in making treatment decisions for their patients deserves national attention,” said Dr. Ginnan. “Medical professionals feel angry and frustrated knowing that unqualified insurance company personnel have the power to override their professional judgement and that the long-term health of their patients is being compromised so health plans can achieve short-term cost savings.”
The survey also identifies specific insurance practices that doctors worry are compromising their patients’ health, including:
- 91 percent state insurers engage in nonmedical switching, which forces stable patients to take less costly and potentially less effective medications.
- 91 percent state that prior authorization, a time-consuming process to get insurers’ approval for a treatment, delays needed care.
- 90 percent criticize step therapy policies, which force patients to try and fail on cheaper, sometimes less effective treatments before plans will cover what doctors prescribe.
“There is growing evidence that insurance practices like prior authorization, step therapy, and nonmedical switching negatively affect clinical outcomes,” said Shannon Ginnan, MD, Director of Medical Affairs for Aimed Alliance and a Virginia-based physician. “While the cost of treatment is a legitimate concern, there is little hope of reducing the burden of serious disease and bending the cost curve for the nation’s health system if insurers ignore the professional judgement of highly trained physicians and deny or delay needed care in the name of cost-control. It is time for common-sense solutions that put patients first.”
Conducted for the Aimed Alliance by David Binder Research, the survey consisted of 600 online interviews with primary care physicians currently practicing in the U.S. between February 25 and March 2, 2018. The margin of sampling error is ± 4.0 percent at the 95 percent confidence level. To read the survey report and its accompanying infographics, click here.
About the Alliance for the Adoption of Innovations in Medicine (Aimed Alliance)
Aimed Alliance is a 501(c)(3) not-for-profit organization that seeks to protect and enhance the rights of health care consumers and providers. We advance our mission by conducting legal research and analysis, developing economically sound policy recommendations, educating the public, and advocating for the enforcement of laws and professional ethics. In conducting these activities, we consult and collaborate with patients, their caregivers, and advocates; clinicians; employers and human resources personnel; and government officials. To learn more about Aimed Alliance, go to www.aimedalliance.org.