How the Internet Is Transforming the Physician-Patient Relationship

James G. Anderson, PhD, Professor of Medical Sociology, Purdue University, West Lafayette, Indiana

In This Article

Disputes Over Access to Online Data

Consumer reports and profiles about the performance of healthcare professionals and organizations are increasingly being made available to the public on Web sites. Consumer advocates argue that disclosure of performance data will help consumers to choose high-quality providers. Opponents argue that performance ratings unfairly penalize healthcare providers and organizations that treat high-risk patients. They argue that surgeons may be discouraged from operating on high-risk patients. They also argue that the public pays little attention to such ratings in choosing a healthcare provider.

A review of the evidence of the effects of public disclosure of performance data is mixed.[14] The only study that found an effect of public disclosure on consumer decision making was the New York State coronary artery bypass graft (CABG) mortality report. The study, updated in January 2001, indicated that hospitals and physicians with better outcomes experienced higher rates of growth in market share after the disclosure of the performance data.

Consumer access to data on the costs of medical procedures is also in dispute. Consumer Web sites have posted the Common Procedural Terminology (CPT) codes and descriptions of medical procedures along with estimated prices based on the amounts the US government reimburses physicians for these procedures. The American Medical Association (AMA) has responded by seeking court orders shutting down the Web sites based on the association's claim to a proprietary right to the CPT codes. The AMA has lobbied the US Congress in support of a bill that would prevent public access to this information.[15]

Consumers are denied access to the National Practitioner Data Bank. This database was created by the US Congress in 1986 and contains information about malpractice awards, civil and criminal actions against physicians, and licensing board decisions. Insurance companies, managed care organizations, and state licensing boards use the data bank. Consumer advocate groups and committee chairs of the commerce committee of the US House of Representatives argue that patients have a right to these data. The AMA and other professional medical groups argue that the data bank contains mostly information about malpractice awards and payments that, in many instances, has little to do with a practitioner's performance. In response to calls for public disclosure, the Federation of State Medical Boards plans to issue a report on the release of performance information. The report will include a model for states to release performance information on healthcare providers.[16] This action may help to assuage the growing consumer demand for additional performance and cost data that can be used in decisions regarding the choice of healthcare providers.


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