Physician altruism may lower health care spending, reduce risk for hospital admissions

Key takeaways:

• Patients of altruistic physicians had improved odds for several health outcomes.
• Practices and policymakers should consider incentives and cultures that improve altruism, the researchers said.

Physician altruism corresponded with more positive patient outcomes, such as lower spending and a reduced risk for hospital admission, a study published in JAMA Health Forum showed.

Lawrence P. Casalino, MD, PhD, MPH, the Livingston Farrand Professor in the department of health care policy and research at Weill Cornell Medical College told Healio that physician professionalism and altruism in health care — defined as putting the patient first — is important for several reasons “but has not been measured in practicing physicians, and there is no research linking professionalism with outcomes.”

In the cross-sectional study, the researchers examined a sample of 250 physicians across 43 medical practices and 7,626 Medicare fee-for-service beneficiaries attributed to the physicians.

Physicians included in the study completed a modified dictator-game style web-based experiment that “asked physicians to allocate real money between themselves and an anonymous other person drawn randomly from the Understanding America Study panel,” Casalino and colleagues explained.

The physicians did not know the experiment was based on altruism — they were instead told it was about physician decision-making — while there was no penalty for allocating all the money to either themselves or the other person.

The payoff of the physician vs. the payoff of the other person determined the degree of altruism of the physician.

Among the cohort, 21% of patients were attributed to 18% of physicians classified as altruistic.

Altruistic and nonaltruistic physicians had similar characteristics except that altruistic physicians were likelier to work in a practice with fewer than 36 physicians.

Casalino and colleagues found that after they adjusted for patient, physician and practice characteristics, patients of altruistic physicians had a:

• 38% reduced risk for potentially preventable hospital admissions (OR = 0.6; 95% CI, 0.38-0.97); and
• 41% reduced risk for potentially preventable ED visits (OR = 0.64; 95% CI, 0.43-0.94).

Meanwhile, the adjusted spending of patients of altruistic physicians was 9.3%, or $800, lower (95% CI, 16.2% to 2.27%).

The researchers explained that patients of altruistic physicians may have better outcomes because their practitioners “choose the most appropriate tests and treatments, and/or because altruistic physicians devote more time and energy to their patients.”

“Our findings that altruistic physicians reported spending more time per patient visit and more time at home on patient care may provide some support for this possible mechanism linking altruism to quality and spending,” they added.

Casalino and colleagues pointed out that although the 18% of physicians classified as altruistic may seem low, only 5% of the U.S. population would be classified as altruistic when the same definition was applied.

There were several study limitations identified by study investigators. For example, because the researchers focused on primary care providers and cardiologists, the results may not be generalizable to other specialties.

Additionally, the results varied based on how the physicians were categorized as altruistic, and it is also possible that healthier patients may have selected more altruistic physicians.

Casalino told Healio that policy makers and medical organization leaders should "give physicians an organizational environment that rewards caring for patients rather than for generating billable services and by limiting the corporatization of medicine."

"Also, perhaps people who select which applicants get admitted to medical school could try to select people who seem likely to be more altruistic," he added.

Casalino said that future research should seek to identify factors, like training, that may shape physician altruism.

"Research could also analyze the relationship between altruism and quality and spending in additional medical practices, specialties, and countries, and use additional measures of quality and of patient experience," he said.