^{Posted on February 10, 2004}

Doctors Support National Insurance- Boston Globe

Doctors Support National Insurance
63% inMass.Survey Support Single-Payer Care
By Liz Kowalczyk, Globe Staff,2/10/04

A majority of Massachusetts doctors support national health insurance, and most said they would be willing to accept a 10 percent cut in fees in return for less paperwork, according to a new study about physicians’ attitudes toward health insurance.

While the four physicians who conducted the survey — all of whom are affiliated withHarvardMedicalSchool— are members of a nonprofit organization that has long pushed for universal health coverage, their results were published today in a respected medical journal, the Archives of Internal Medicine. The study is part of a growing body of research into physicians’ views toward national health insurance that is sparking debate on the topic as the number of uninsured Americans has grown to 41 million.

A study published three years ago in the New England Journal of Medicine showed a majority of medical school faculty and doctors-in-training believed a “single-payer system”— where one government entity manages and pays for everyone’s medical care — would provide the best care to the most patients for a fixed amount of money. They chose that option over managed care or fee-for-service, in which insurance companies pay doctors and hospitals based on the treatment. Managed care and fee-for-service are the two most common types of private insurance.

The study published today was based on a survey of 904Massachusettsdoctors and included doctors at teaching hospitals as well as those who see patients in private offices.

About 63 percent chose single-payer as the best system; 26 percent picked fee-for-service, and just 11 percent favored managed care. About 67 percent of doctors agreed somewhat or agreed strongly that they’d take a 10 percent reduction in fees in return for “a very substantial reduction in my paperwork.” And 57 percent said they agreed with a salary system if salaries are “guaranteed to be within 10 percent of their previous incomes.”

Psychiatrists and primary care doctors showed the strongest support for a single-payer system, while surgeons favored it the least. Just 47 percent of surgeons believed a single-payer system would provide the best healthcare to the most patients. Dr. Steffie Woolhandler, one of the authors and a physician at Cambridge Hospital, said surgeons earn 50 to 100 percent more than other doctors. “This may explain their lower support for tinkering with the payment system,” she said.

Robert Blendon, a professor of health policy and political analysis at the Harvard School of Public Health, said the study has a key weakness: The authors did not give doctors enough choices. In other words, the terms “single-payer” could mean different things to different physicians. The authors remarked in their study that they believe most physicians are familiar with the general term as referring to some type of national government health insurance system.

But a study three months ago published in the Annals of Internal Medicine reported that 49 percent of 1,650 doctors surveyed support government legislation to establish national health insurance. But only 26 percent of the physicians favored a program in which government would pay for all healthcare. Instead, doctors wanted tax credits or employer mandates to achieve universal coverage. Blendon also points out that managed care and a single-payer system are not mutually exclusive. A single-payer system could include a managed care component to tightly manage and control care and costs.

”Physicians would like to see people covered, but given a choice how to do it, they might pick other ways,” he said. “There’s no question, though, that they’d like to get rid of managed care.”