Most Clinicians Are Against Money-Back Healthcare Guarantees

Marcia Frellick

May 31, 2019

Most physicians and nurses would not support physicians or hospitals offering refunds or rebates if patients found their care unsatisfactory, a recent Medscape poll shows.

The poll followed a story in Medscape Medical News that reported in China Pfizer has offered to reimburse up to 33% of the cost of its breast cancer drug palbociclib (Ibrance) if a patient's disease progresses within 4 months. That offer is not good in the United States, where the average cost for the drug is nearly $13,000 for one bottle of 21 capsules.

Nurses More Likely to Support Money Back

Nurses and advanced practice registered nurses (APRNs) were much more supportive of money-back guarantees. When asked, in general, whether providers would support physicians offering refunds or rebates to unsatisfied patients, 36% of nurses/APRNs favored the idea vs 19% of physicians who answered that way.

Seventy-five percent of physicians were opposed to that idea vs 40% of nurses/APRNs who were opposed.

Both groups were more likely to favor the concept when the entity offering the refund or rebates was a hospital. In that case, 43% of nurses/APRNs and 24% of physicians said they would favor the idea. Twice as many physicians as nurses/APRNs were opposed to hospital rebates (69% vs 35%).

The most support came when the entity offering the refunds or rebates was a pharmaceutical company.

Nearly 70% of nurses/APRNs (69%) supported pharma guarantees vs 35% of physicians.

The poll, first posted on March 20, drew responses from 134 nurses/APRNs and 85 physicians for a total of 219 responses.

A "Flood Gate"

The poll story drew more negative than positive comments from subscribers.

A nurse practitioner wrote, "This is like offering a refund to people who died in a plane crash because a volcano suddenly exploded 1,000 miles away. There are way too many variables in the human body to 'guarantee' anything."

A pediatrician commented, "Money back policy in health care is unethical and it will open a flood gate."

Another healthcare provider described the issue as "challenging," particularly because so many factors play a part in whether patients are satisfied. The person gave this example: "I can be nonresponsive to certain treatment, and that does not mean that the product failed, but that I am not responsive. Should I be reimbursed?"

However, a psychologist liked the idea of guarantees, writing, "I promise you, unnecessary interventions without consent and rude nurses will disappear if there was a money back guarantee option. Same about noise on the hospital floor where patients cannot get a good [night's] sleep. Results of treatment cannot be guaranteed but there are aspects that can be controlled and if nothing else helps, money back is not such a bad idea."

A nurse practitioner wrote: "As long as healthcare/medicine is run as a business with competing claims, there should be satisfaction guarantees. Possible outcomes and side effects should be fully explained as well as the risks involved."

Money Back Not Unprecedented

The idea of a guaranteed healthcare experience is not unprecedented in the United States.

In a 2018 interview with Medscape Editor-in-Chief Eric Topol, MD, David Feinberg, MD, who was then CEO of Geisinger Health System, described Geisinger's "proven experience."

"If there's any part of your care that you're not satisfied with," he said, "we offer a no-questions-asked, money-back guarantee. You can have all or some or whatever you want of what you paid back.

"We have returned millions of dollars to our patients, and they have been the best secret shopper program ever. They tell us what's working and what's not working.

"For example, just the other day a woman had surgery and left all kinds of positive comments about the doctor and the nurses, but she had three complaints: the IV infiltrated; there was construction on the floor above that we said would end at 9:00 but it lasted until 10:00; and one of the nurses wasn't very kind about helping her to the commode.

"This woman had paid $2000 out of pocket for the surgery, and she asked for $150 back. To me, it's worth $150 to find out how we can get better and whom we need to compliment for doing well."

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