Health insurance companies hold too much sway over patient care, doctors say

Health insurance companies have too much sway over treatment decisions that physicians and patients should be making, according to results of a new survey.

Sermo, a social networking site for doctors, found a disparity among physicians in the United States, Europe, and elsewhere around the world. In the U.S., 78% of physicians feel health insurance companies hold too much influence by approving or denying procedures and treatments for patients. Those feelings drop to 52% globally, and 38% in European nations, according to the findings of Sermo’s latest Barometer study of 529 doctors across a range of specialties.

“Navigating health insurance policies has become one of the most significant obstacles to providing care,” Sermo Medical Advisory Board Member Shivang Joshi, MD, MPH, RPh, FAHS, said in a news releases. Joshi is director of headache medicine at Community Neuroscience Services in Westborough, Massachusetts.

“Every day, we find ourselves in battles over approvals for medications or procedures we know our patients desperately need,” Joshi said. “The frustration comes from knowing that these decisions are often made by individuals who lack the specific medical expertise and simply follow antiquated algorithms, yet hold immense power over care decisions. It’s heartbreaking to explain to a patient that their care is delayed – not because of medical reasons, but because of their insurance.”

Private equity and health care

Private equity (PE) investment in health care has made headlines and drawn the attention of doctors, patients, and federal regulators questioning how it could affect the sector. In the Sermo poll, 54% of U.S. physicians said they feel private equity investments lead to lower quality of patient care. A full 26% said they felt PE investment leads to a significant decline in quality, while just 2% said they have seen significant improvement in care with that investment.

“The challenges of U.S. physicians operating in private equity systems prioritizing profits are well-documented,” Sermo’s news release said. Sermo cited a study announced this month by the U.S. National Institutes of Health that found hospitals purchased by private equity firms “had a substantial increase in infections, falls, and other adverse events.”

Despite potential drawbacks including worse patient care, Sermo said practice owners likely see private equity as an attractive option due to the administrative burdens and the financial implications for their practices. Currently, North America leads the world in private equity deals in health care, representing 65% of global deal value, Sermo said, citing Bain & Company’s “Healthcare Private Equity Market 2024: Year in Review and Outlook” report.