Effect of Financial Relationships on the Behaviors of Health Care Professionals: A Review of the Evidence
Article first published online: 12 OCT 2012
© 2012 American Society of Law, Medicine & Ethics, Inc.
The Journal of Law, Medicine & Ethics
Special Issue: SYMPOSIUM 1: Conflicts of Interest in the Practice of Medicine
Volume 40, Issue 3, pages 452–466, Fall 2012
How to Cite
Robertson, C., Rose, S. and Kesselheim, A. S. (2012), Effect of Financial Relationships on the Behaviors of Health Care Professionals: A Review of the Evidence. The Journal of Law, Medicine & Ethics, 40: 452–466. doi: 10.1111/j.1748-720X.2012.00678.x
- Issue published online: 12 OCT 2012
- Article first published online: 12 OCT 2012
This paper explores the empirical evidence regarding the impact 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, and (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.