How the reimbursement system may influence physicians' decisions results from focus groups interviews in France.

This paper analyzes how physicians' treatment choices are influenced by cost to the patient for four different diseases in France: mild hypertension, hay fever, dyspepsia and hormone replacement therapy (HRT). Five focus groups of physicians were conducted in the fall of 1998. The paper reviews the type of shifts and strategies physicians used to reduce the cost to the patient. In order to maintain access to care for the patients, the most common strategy used is to refer to different types of social structures in the health care system. However, a number of shifts related to drug or treatment choices were also identified such as prescription of older drugs, shifts to drugs having different drug coverage and cheaper drugs within a drug class. In a proportional system of copayment, the price level of the services (drugs or exams) clearly appeared as a determining factor to induce physicians' decision shifts. Overall, we also found that French physicians put higher priorities on the cost to society than on the cost to the patient in their treatment decisions.