BACKGROUND & AIMS:
BACKGROUND:Little is known about how U.S. physicians' political affiliations, specialties, or sense of social responsibility relate to their reactions to health care reform legislation.
OBJECTIVE:To assess U.S. physicians' impressions about the direction of U.S. health care under the Affordable Care Act (ACA), whether that legislation will make reimbursement more or less fair, and examine how those judgments relate to political affiliation and perceived social responsibility.
DESIGN:A cross-sectional, mailed, self-reported survey.
PARTICIPANTS:Simple random sample of 3,897 U.S. physicians.
MAIN MEASURES:Views on the ACA in general, reimbursement under the ACA in particular, and perceived social responsibility.
KEY RESULTS:Among 2,556 physicians who responded (RR2: 65 %), approximately two out of five (41 %) believed that the ACA will turn U.S. health care in the right direction and make physician reimbursement less fair (44 %). Seventy-two percent of physicians endorsed a general professional obligation to address societal health policy issues, 65 % agreed that every physician is professionally obligated to care for the uninsured or underinsured, and half (55 %) were willing to accept limits on coverage for expensive drugs and procedures for the sake of expanding access to basic health care. In multivariable analyses, liberals and independents were both substantially more likely to endorse the ACA (OR 33.0 [95 % CI, 23.6-46.2]; OR 5.0 [95 % CI, 3.7-6.8], respectively), as were physicians reporting a salary (OR 1.7 [95 % CI, 1.2-2.5]) or salary plus bonus (OR 1.4 [95 % CI, 1.1-1.9) compensation type. In the same multivariate models, those who agreed that addressing societal health policy issues are within the scope of their professional obligations (OR 1.5 [95 % CI, 1.0-2.0]), who believe physicians are professionally obligated to care for the uninsured / under-insured (OR 1.7 [95 % CI, 1.3-2.4]), and who agreed with limiting coverage for expensive drugs and procedures to expand insurance coverage (OR 2.3 [95 % CI, 1.8-3.0]), were all significantly more likely to endorse the ACA. Surgeons and procedural specialists were less likely to endorse it (OR 0.5 [95 % CI, 0.4-0.7], OR 0.6 [95 % CI, 0.5-0.9], respectively).
CONCLUSIONS:Significant subsets of U.S. physicians express concerns about the direction of U.S. health care under recent health care reform legislation. Those opinions appear intertwined with political affiliation, type of medical specialty, as well as perceived social responsibility.
背景与目标:
背景:关于美国医生的政治背景,专长或社会责任感与他们对医疗改革立法的反应之间的关系知之甚少。
目的:评估《可负担医疗法案》(ACA)下美国医生对美国医疗保健方向的印象,该立法是否会使报销或多或少是公平的,并研究这些判断与政治归属和可察觉的社会责任之间的关系。
设计:横断面,邮寄,自我报告的调查。
参与者:3,897名美国医生的简单随机样本。
主要指标:对ACA的总体看法,尤其是ACA下的报销,以及感知到的社会责任。
关键结果:在做出回应的2556名医生中(RR2:65%),大约五分之二(41%)认为ACA将使美国的医疗保健朝着正确的方向发展,并使医师的报销不太公平(44%)。 72%的医生认可了解决社会卫生政策问题的一般专业义务,65%的人同意每位医生都有专业义务照顾未投保或未投保的保险,一半(55%)的人愿意接受针对昂贵医疗保险的限额药物和程序,以扩大获得基本医疗保健的机会。在多变量分析中,自由主义者和独立者都更有可能认可ACA(分别为OR 33.0 [95%CI,23.6-46.2]; OR 5.0 [95%CI,3.7-6.8]),医生报告的是薪水(OR 1.7 [95%CI,1.2-2.5])或薪金加奖金(OR 1.4 [95%CI,1.1-1.9)薪酬类型。在相同的多元模型中,那些同意解决社会卫生政策问题在其专业义务范围内的人(OR 1.5 [95%CI,1.0-2.0]),他们相信医师在专业上有义务照顾未保险的/未成年人保险(OR 1.7 [95%CI,1.3-2.4]),并同意限制昂贵药物的承保范围和扩大保险范围的程序(OR 2.3 [95%CI,1.8-3.0]),都明显更有可能认可ACA。外科医生和程序专家不太可能认可它(OR 0.5 [95%CI,0.4-0.7],或0.6 [95%CI,0.5-0.9])。
结论:根据最近的医疗保健改革立法,相当一部分美国医师对美国医疗保健的方向表示担忧。这些意见似乎与政治派别,医疗专业的类型以及人们认为的社会责任交织在一起。