Attitudes on Equal Health Care Access versus Efficient Clinical Decisions across a Not-for-Profit Health Care System

Abstract

Background Professional roles within a hospital system may influence attitudes behind clinical decisions. Objective To determine participants’ preferences about clinical decisions that either value equal health care access or efficiency. Design Deidentified survey asking participants to choose between offering a low-cost screening test to a whole population (“equal access”) or a more sensitive, expensive test that could be given to only half of the population but resulting in 10% more avoided deaths (“efficient”). Data collection took place from August 18, 2021, to January 24, 2022. Study 1644 was determined to be exempt by Tufts Health Sciences Institutional Review Board (IRB). Setting Tufts Medicine Healthcare System. Participants Approximately 15,000 hospital employees received an e-mail from the Tufts Medicine Senior Vice President of Academic Integration. Measurements Analysis of survey responses with chi-square and 1-sample t tests to determine the proportion who chose each option. Logistic regression models fit to examine relationships between professional role and test choice. Results A total of 1,346 participants completed the survey (∼9.0% response rate). Overall, approximately equal percentages of respondents chose the “equal access” (48%) and “efficient” option (52%). However, gender, professional role (categorical), and clinical role (dichotomous) were significantly associated with test choice. For example, among those in nonclinical roles, women were more likely than men to choose equal health care access. In multivariable analyses, having clinical roles was significantly associated with 1.73 times the likelihood of choosing equal access (95% confidence interval = 1.33–2.25). Limitations Generalizability concerns and survey question wording limit the study results. Conclusion Clinicians were more likely than nonclinicians to choose the equal health care access option, and health care administrators were more likely to choose efficiency. These differing attitudes can affect patient care and health care quality. Highlights Divergent preferences of valuing equal health care access and efficiency may be in conflict during clinical decision making. In this cross-sectional study that included 1,346 participants, approximately equal percentages of respondents chose the “equal access” (48%) and “efficient” option (52%), a nonsignificant difference. However, gender, professional role (categorical), and clinical role (dichotomous) were significantly associated with test choice Since clinicians were more likely than nonclinicians to choose the equal health care access option and health care administrators were more likely to choose efficiency, these differing attitudes can affect patient care and health care quality.