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Effect of Financial Relationships on the Behaviors of Health Care Professionals: A Review of the Evidence

40 Journal of Law, Medicine, & Ethics 452 (2012)

Arizona Legal Studies Discussion Paper No. 12-30

44 Pages Posted: 2 Aug 2012 Last revised: 14 Apr 2013

Christopher T. Robertson

University of Arizona - James E. Rogers College of Law; Harvard University - Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics

Susannah L. Rose

Cleveland Clinic, Department of Bioethics; Case Western Reserve University; Edmond J. Safra Center for Ethics at Harvard University

Aaron S. Kesselheim

Brigham and Women's Hospital/Harvard Medical School; Harvard University - Edmond J. Safra Center for Ethics

Date Written: August 1, 2012

Abstract

This symposium paper explores the empirical evidence regarding the impact of financial relationships on the behavior of health care providers, specifically, physicians. We identify and synthesize peer-reviewed data addressing whether financial incentives are causally related to patient outcomes and health care costs. We cover three main areas where financial conflicts of interest arise and may have an observable relationship to health care practices: physicians’ roles as self-referrers, insurance reimbursement schemes that create incentives for certain clinical choices over others, and financial relationships between physicians and the drug and device industries. We found a well-developed scientific literature consisting of dozens of empirical studies, some that allow stronger causal inferences than others, but which altogether show that such financial conflicts of interests can, and sometimes do, impact physicians’ clinical decisions. Further research is warranted to document the causal relationship of such changes on health outcomes and the cost of care, but the current base of evidence is sufficiently robust to motivate policy reform.

Keywords: incentives, conflicts of interest, medical decision making, bias, self-referral, industry, insurance, pay for performance

JEL Classification: I11

Suggested Citation

Robertson, Christopher T. and Rose, Susannah L. and Kesselheim, Aaron S., Effect of Financial Relationships on the Behaviors of Health Care Professionals: A Review of the Evidence (August 1, 2012). 40 Journal of Law, Medicine, & Ethics 452 (2012); Arizona Legal Studies Discussion Paper No. 12-30. Available at SSRN: https://ssrn.com/abstract=2121535

Christopher T. Robertson (Contact Author)

University of Arizona - James E. Rogers College of Law ( email )

P.O. Box 210176
Tucson, AZ 85721-0176
United States

HOME PAGE: http://www.law.arizona.edu/faculty/getprofile.cfm?facultyid=714

Harvard University - Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics ( email )

23 Everett Street
Cambridge, MA 02155
United States

Susannah L. Rose

Cleveland Clinic, Department of Bioethics ( email )

9500 Euclid Ave.
Cleveland, OH 44195
United States

Case Western Reserve University ( email )

2511 Overlook Road
Cleveland Heights, OH 44106
United States

Edmond J. Safra Center for Ethics at Harvard University ( email )

124 Mount Auburn Street
Suite 520N
Cambridge, MA 02138
United States

Aaron S. Kesselheim

Brigham and Women's Hospital/Harvard Medical School ( email )

1620 Tremont St
Suite 3030
Boston, MA 02120
United States
617-278-0930 (Phone)
617-232-8602 (Fax)

HOME PAGE: http://www.drugepi.org/portal

Harvard University - Edmond J. Safra Center for Ethics ( email )

124 Mount Auburn Street
Suite 520N
Cambridge, MA 02138
United States

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