By Andrew Doughman
McClatchy-Tribune News Service
Doctors in nine states last month avoided what some saw as an unwelcome “mystery shopper” patient: the federal government.
Government researchers were poised to secretly study doctors until public outcry scuttled the proposal. But some doctors now are saying the government made a mistake and that fear essentially derailed a study that could have provided important results about patients’ access to care.
“Some critics argue that such inherently deceptive study designs are unethical. But concealment is frequently used in experiments to avoid biasing results,” wrote Dr. Karin Rhodes in a commentary published last week in the New England Journal of Medicine. “In this case, the public, patients, and health care providers all benefit.”
The federal Department of Health and Human Services had wanted to study how difficult it is for patients to get care when they need it and how their insurance played into that.
In the national study, government researchers would have posed as prospective patients and called primary care physicians to schedule appointments. They wanted to gather data about wait times to measure the extent of the oft-reported shortage of primary-care physicians.
While government researchers would not identify themselves as working for the government, they also would not have released the names of doctors.
When the story was first reported in the New York Times, some doctors decried the study for using intentionally deceptive “Big Brother tactics” that reduced their trust in government.
Rhodes wrote that these “secret shopper” studies are common and have a long history of measuring discrimination in employment, housing and mortgage markets.
Calling them audits, she said patients deserve to know average wait times and access to care based on the type of insurance they have, even if government workers posed as patients in order to gather that data.
The question of access is important because as many as 38 million Americans are expected to gain health insurance in 2014 under the federal health-care overhaul.
“Without reliable national baseline measures of access, how will anyone know whether health care reform is improving access to care or making it worse?” Rhodes asked.
Studies have shown that there already is a nationwide shortage of primary-care physicians. Millions more Americans with health insurance may exacerbate the shortage as more people seek care from a pool of doctors that isn’t growing to meet demand.
Because this is known, some doctors had criticized the federal government for proposing a redundant study that wasted taxpayer money. Others said it was worthwhile.
“I think that maybe they’re trying to validate the fact that there’s a primary-care shortage,” said Mark Dickinson, CEO of Community Health Centers, Inc. in Central Florida.
Rhodes, however, said there are “many gaps” in the data.
When the government cancelled the study just days after it was announced, a spokesman for the Department of Health and Human Services denied politics were involved, saying only that the government “determined that now is not the time to move forward with this research project.”
With the study on indefinite hold, the federal government is searching for other, less controversial ways to measure access to primary care.