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

Law professor Christopher Robertson and two
medical colleagues have a new paper forthcoming in the Journal
of Law, Medicine and Ethics, titled "Effect of
Financial Relationships on the Behaviors of Health Care Professionals: A Review
of the Evidence."  Here is the abstract:

This 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: 

1.    
Physicians’ roles as self-referrers

2.    
Insurance reimbursement schemes that create incentives for
certain clinical choices over others

3.    
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.