The moral psychology of rationing among physicians: the role of harm and fairness intuitions in physician objections to cost-effectiveness and cost-containment

Introduction

Physicians vary in their moral judgments about health care costs. Social intuitionism posits that moral judgments arise from gut instincts, called “moral foundations.” The objective of this study was to determine if “harm” and “fairness” intuitions can explain physicians’ judgments about cost-containment in U.S. health care and using cost-effectiveness data in practice, as well as the relative importance of those intuitions compared to “purity”, “authority” and “ingroup” in cost-related judgments.

Methods

We mailed an 8-page survey to a random sample of 2000 practicing U.S. physicians. The survey included the MFQ30 and items assessing agreement/disagreement with cost-containment and degree of objection to using cost-effectiveness data to guide care. We used t-tests for pairwise subscale mean comparisons and logistic regression to assess associations with agreement with cost-containment and objection to using cost-effectiveness analysis to guide care.

Results

1032 of 1895 physicians (54%) responded. Most (67%) supported cost-containment, while 54% expressed a strong or moderate objection to the use of cost-effectiveness data in clinical decisions. Physicians who strongly objected to the use of cost-effectiveness data had similar scores in all five of the foundations (all p-values?>?0.05). Agreement with cost-containment was associated with higher mean “harm” (3.6) and “fairness” (3.5) intuitions compared to “in-group” (2.8), “authority” (3.0), and “purity” (2.4) (p?<?0.05). In multivariate models adjusted for age, sex, region, and specialty, both “harm” and “fairness” were significantly associated with judgments about cost-containment (OR?=?1.2 [1.0-1.5]; OR?=?1.7 [1.4-2.1], respectively) but were not associated with degree of objection to cost-effectiveness (OR?=?1.2 [1.0-1.4]; OR?=?0.9 [0.7-1.0]).

Conclusions

Moral intuitions shed light on variation in physician judgments about cost issues in health care.

     

Healing Rituals for Couples Recovering from Adultery

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The Effect of Later Life Parental Divorce on Adult‐Child/Older‐Parent Solidarity: A Test of the Buffering Hypothesis1

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Auditory and audiovisual inhibition of return

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Three experiments investigated cross-modal links between touch, audition, and vision in the control of covert exogenous orienting. In the first two experiments, participants made speeded discrimination responses (continuous vs. pulsed) for tactile targets presented randomly to the index finger of either hand. Targets were preceded at a variable stimulus onset asynchrony (150,200, or 300 msec) by a spatially uninformative cue that was either auditory (Experiment 1) or visual (Experiment 2) on the same or opposite side as the tactile target. Tactile discriminations were more rapid and accurate when cue and target occurred on the same side, revealing cross-modal covert orienting. In Experiment 3, spatially uninformative tactile cues were presented prior to randomly intermingled auditory and visual targets requiring an elevation discrimination response (up vs. down). Responses were significantly faster for targets in both modalities when presented ipsilateral to the tactile cue. These findings demonstrate that the peripheral presentation of spatially uninforrnative auditory and visual cues produces cross-modal orienting that affects touch, and that tactile cues can also produce cross-modal covert orienting that affects audition and vision.