A Medical Dilemma: How Should Physicians Respond to Patients’ Questions About Pay?

Managed care organizations use physician incentives to control costs and ensure their financial viability. While the efficacy of incentives may be questioned, substantial challenges exist for physicians who must balance the well-being of their patients and the focus of their professional training with organizational financial concerns. Many physicians experience difficulty in discussing incentive pay with patients (Pearson & Hyams, 2002), even though patients want to know (Pereira & Pearson, 2001) and tend to trust physicians more who are forthright about the issue (Levinson, Kao, Kuby, & Thisted, 2005). Of interest here are patients’ perceptions of the ethicalness of commonly used physician pay incentives. The results of our findings suggest that patients may view these incentives from a different perspective than health policy experts and physician executives. Specifically, our findings indicate that patients perceive incentives based upon patient satisfaction and clinical efficiency more ethically than incentives based upon revenue generation. These views are significantly related to physician visits. We offer suggestions for future research in light of recent pay disclosure regulations.