Cited by 254Healthcare cost, quality, practicesHealthcare Policy and ManagementPrimary Care and Health Outcomes

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Discretionary Decision Making By Primary Care Physicians And The Cost Of U.S. Health Care

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Sirovich, Brenda, Gallagher, Patricia M., Wennberg, David E., Fisher, Elliott S.·2008·Health Affairs

DOI 10.1377/hlthaff.27.3.813PMC PMC2438037

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Abstract

Efforts to improve the quality and costs of U.S. health care have focused largely on fostering physician adherence to evidence-based guidelines, ignoring the role of clinical judgment in more discretionary settings. We surveyed primary care physicians to assess variability in discretionary decision making and evaluate its relationship to the cost of health care. Physicians in high-spending regions see patients back more frequently and are more likely to recommend screening tests of unproven benefit and discretionary interventions compared with physicians in low-spending regions; however, both appear equally likely to recommend guideline-supported interventions. Greater attention should be paid to the local factors that influence physicians' clinical judgment in discretionary settings.

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Authors: Sirovich, B., Gallagher, P. M., Wennberg, D. E., & Fisher, E. S.
Affiliations: Veterans Health Administration (US)
White River Junction, Vermont
ORCID: Gallagher, Patricia M.
Fisher, Elliott S.
Venue: Health Affairs
Publisher: Health Affairs Publishing, LLC
Published: 2008-05
Volume: 27
Issue: 3
Pages: 813-823
ISSN: 0278-2715 (ISSN-L)
1544-5208
DOI: 10.1377/hlthaff.27.3.813
PMC: PMC2438037
OpenAlex: W1970716113
Cited by: 253
References: 34
Citations by year: 2026: 4 · 2025: 1 · 2023: 3 · 2022: 6 · 2021: 6 · 2020: 9 · 2019: 20 · 2018: 10 · 2017: 14 · 2016: 16 · 2015: 20 · 2014: 25 · 2013: 21 · 2012: 22
FWCI: 48.21
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: Health Affairs (publishedVersion)
PubMed (publishedVersion)
PubMed Central (acceptedVersion)
Funders: National Institute on Aging (P01AG19783, P01AG019783)
National Heart, Lung, and Blood Institute (R01HL080437)
Topics: Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
Health Sciences › Medicine › Family Practice › Primary Care and Health Outcomes
Keywords: discretionary decision-making, clinical judgment, primary care physicians, health care costs, guideline adherence, quality of care
MeSH terms: Decision Making, Health Services, Humans, Hypertension, Practice Patterns, Physicians', Physicians, Family, Primary Health Care, United States, Health Care Costs, Health Care Surveys

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Discretionary Decision Making By Primary Care Physicians And The Cost Of U.S. Health Care

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