The Article in Brief

Background It is widely recognized that Americans without health insurance receive fewer health services and have worse health than those with insurance. Until now, however, there has been little research into whether patients’ insurance status affects doctors’ medical decision making during office visits. In this study, primary care doctors share their perspectives on whether patients’ insurance status affects their medical management of patients during office visits.

What This Study Found Twenty-five doctors in Washington, DC, completed surveys of 409 office visits. Twenty-two (88%) of the doctors reported making at least 1 change in their medical management of patients because of the patients’ insurance status. Doctors took patients’ insurance into account during 193 (47.2%) of 409 office visits. Visits by uninsured patients were most likely to include changes in medical management decisions, whereas visits by privately insured patients were least likely to include such changes.

Implications

• Primary care doctors consider their patients’ health insurance status when they make medical decisions during office visits.
• In this study, doctors considered insurance in almost one half of patient visits and changed their medical management in almost one quarter of visits.
• Additional research is needed to understand the effect of these changes on patient health and to help doctors and patients get the best quality of care within the limitations of the current health ins