Specialty, Political Affiliation, and Perceived Social Responsibility Are Associated with U.S. Physician Reactions to Health Care Reform Legislation

• Published in: Journal of general internal medicine : JGIM 2014-02, Vol.29 (2), p.399-403
• Main Authors: Antiel, Ryan M., James, Katherine M., Egginton, Jason S., Sheeler, Robert D., Liebow, Mark, Goold, Susan Dorr, Tilburt, Jon C.
• Format: Article
• Language: English
• Subjects: Adult; Attitude of Health Personnel; Attitude surveys; Biological and medical sciences; Cross-Sectional Studies; Data Collection - methods; Data Collection - trends; Female; General aspects; Health care policy; Health Care Reform - legislation & jurisprudence; Health Care Reform - trends; Health participants; Humans; Internal Medicine; Male; Medical sciences; Medicine; Medicine & Public Health; Medicine - trends; Middle Aged; Miscellaneous; Original Research; Patient Protection & Affordable Care Act 2010-US; Patient Protection and Affordable Care Act - legislation & jurisprudence; Patient Protection and Affordable Care Act - trends; Perception; Physicians; Physicians - psychology; Physicians - trends; Politics; Public health. Hygiene; Public health. Hygiene-occupational medicine; Self Report; Social Responsibility; United States - epidemiology
• ISSN: 0884-8734; 1525-1497
• DOI: 10.1007/s11606-013-2523-0

ABSTRACT 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 special