“Altruistic” doctors put patients before profits — and achieve better results, study finds

“Altruistic” doctors who prioritize patient care over income and profit achieve dramatically better health outcomes with older patients, a finding that has powerful implications for U.S. health care systems and policies, according to a new study co-authored at UC Berkeley.

The research, published today in JAMA Health Forum, found that when thousands of Medicare patients were treated by such doctors, they were far less likely to need preventable hospital admissions and emergency room visits. In addition, the patients’ annual medical payments were nearly 10% lower on average.

“The bottom line is that the more altruistic doctors are actually providing better medical care,” said co-author Shachar Kariv, a Berkeley theoretical economist. “This means that we can, on the one hand, really improve medical care, and on the other hand pay less for it — if doctors are altruistic.

“Given that medical expenses are the single biggest fraction of U.S. gross domestic product, the implications are absolutely enormous.”

The paper, “Physician Altruism and Spending, Hospital Admissions and Emergency Department Visits,” appears to be the first data-based effort to explore the link between doctors’ altruism and patients’ health care quality and expenses. Health Forum is published by the Journal of the American Medical Association (JAMA).

The findings come at a time when doctors and other medical staff are under increasing pressure from insurance companies, hospital systems, medical groups and government medical agencies to tip their priorities toward profit or cost reductions.

As a result, the researchers reported, doctors may spend less time with patients or may order procedures that generate profit even if they’re not essential for the patient. That leads to significant disparities in care and medical outcomes, with evident advantages for the patients of altruistic doctors.

The researchers found that those patients had:

• 38% fewer potentially preventable hospitalizations;
• 41% fewer potentially preventable emergency room visits; and
• annual medical expenses that were more than 9% lower.

“Patients of altruistic physicians might have better outcomes because their physicians choose the most appropriate tests and treatments, and/or because altruistic physicians devote more time and energy to their patients,” the authors wrote.

In U.S. medical culture, altruism is a fundamental ethical value, holding that medical workers should put the patient before all other interests.

“There is an oath — they are basically swearing to do this,” Kariv explained. “What we expect from doctors is not what we expect from salespeople.”

The study, completed in August, covered more than 7,600 Medicare patients with an average age of 76, slightly more than half of whom were women. They were under the care of 250 doctors at 43 medical practices, all of them specialists in three common areas: internal medicine, family practice and cardiology.

The doctors’ altruism was assessed in a brief online game in which they had to make a set of decisions to allocate a pool of money between themselves and another, anonymous person. Based on an evaluation of their decision-making, 45 of the doctors in the study, or 18% of them, were classified as altruistic, while 205 were not.

Both groups featured a similar proportion of male and female doctors. One key difference: Doctors classified as altruistic were more likely to work in smaller medical practices.

To reach their conclusions, the researchers studied the patients’ Medicare claims, plus doctors’ own reports on how much time they spent with each patient, how many patients they saw in a typical three-hour period and how much time they spent on patient care while at home.

The changes needed to encourage medical altruism

According to Kariv and other authors, the research raises critical questions about the short-term, profit-focused values and incentives that govern much of American medicine and shape day-to-day treatments provided by doctors to their patients.

Aggressive efforts to control costs and maximize profit may ultimately harm patients and raise systemwide costs, they suggest. Instead, a stronger patient-first focus might cost more up front while producing lower costs and greater savings in the long run.

Kariv, the former chair of Berkeley’s economics department, has done a range of studies that look at how trade-offs shape economic behavior. For example, the trade-off between risk and reward underlies much economic decision-making. Trade-offs can also shape medical treatment decisions.

“In this paper, we’re talking about the trade-off between my own well-being and the well-being of other people — a complete stranger, not my son or my wife,” he said. “It’s very true for medical doctors: They can prescribe you a medicine or a treatment and they will actually get financial benefits out of it.”

Doctors “are absolutely aware of this” as they make treatment decisions, he added.

How to increase altruism as a force in medicine? The authors say that broad social and economic change might be required, from medical school admissions and training to the financial rewards and penalties that shape doctors’ care decisions.

“Policymakers and leaders of hospitals, medical practices, and medical schools may want to consider creating incentives, organizational structures and cultures that seem likely to increase, or at least not decrease, physician altruism,” they concluded.

The co-authors of the paper represent a broad spectrum of disciplines in economics, health and philosophy. Co-author Jing Li, a health economist at the University of Washington who specializes in medical decision-making, got her master’s degree and PhD from the UC Berkeley School of Public Health.