ANN ARBOR, MI - At a time when health care costs are rising, a new study led by a University of Michigan Health System doctor finds that many physicians think their efforts at saving money don't directly impact patients.

Physicians who choose more expensive medical test options believe, according to study results, that money saved by using a less expensive approach would go toward the profits and salaries of insurance companies and their executives and not to improved clinical services or reduced insurance premiums for patients.

"Health care inflation has reared its ugly head again. We thought we had it under control with managed care but we were wrong. It's back and rising quickly" - and physician perceptions may be to blame, says Peter Ubel, M.D., senior author of the study, which will be published in the June issue of the American Journal of Managed Care. Ubel is associate professor of internal medicine at the University of Michigan Medical School and director of the U-M Health System's Program for Improving Health Care Decisions.

Ubel and a team of researchers from the University of Pennsylvania sent primary care physicians a series of scenarios presenting a choice between an effective but less expensive cancer screening or a more expensive and somewhat more effective alternative. Physicians also were asked who they thought would see the cost savings if they chose the less expensive option.

The questions included issues such as: Would you routinely choose flexible sigmoidoscopy or the more expensive colonoscopy to screen for colon cancer? Should a healthy 22-year-old woman with no history of cervical cancer receive a Pap smear every year or every three years? Should women with normal risk of breast cancer begin having mammograms at age 40 or 50?

Slightly more than half of the 865 physicians nationwide who responded chose the more expensive screening. Of that group, 77 percent said they felt any money saved through the other option would go to the managers and owners of insurance companies. Of those physicians choosing the less expensive option, more than half felt insurance companies would benefit from the savings. Physicians in small private practices were more likely to say savings would go to the insurance companies.

When managed care, with its emphasis on preventative medicine, boomed in the 1980s, it was intended to help control costs of medical care, which had skyrocketed in recent decades. It worked well for awhile, bringing down health care inflation rates significantly. But growth rates have surged again recently, and as the nation looks at ways to bring health insurance and prescription drug coverage to everyone, cost has been a central issue.

"Health care spending is very rarely determined at a policy level. Instead, it's the doctors making one decision at a time for each patient they see," Ubel says. "Doctors still have a huge impact on health decisions they make with their patients. If they're sitting down with a patient and it comes to a decision of one treatment over another, they're going to ask who benefits by saving money. If the doctors knew that extra money would go straight to the patient's pocket, it would be considered patient advocacy to save that money."

And ultimately, health care spending levels do affect patients. Savings would eventually lead to increased services, lower premiums, or higher salaries as employers see the cost of providing health care come down. Health care costs are increasing at the highest rate in 20 years, according to the National Committee for Quality Insurance.

"This study shows that many doctors think only of the first place the money goes," Ubel says. "Those long-run societal benefits don't seem as compelling when benefits to particular stakeholders appear more immediate."

The study was funded by the National Cancer Institute and included researchers from the University of Pennsylvania and the Veterans Affairs medical centers in Ann Arbor, Mich., and Philadelphia.

Written by: Nicole Fawcett

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