Payment bias

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Is there a payment bias?

What I mean by that is, are those that pay to be seen by a clinician more likely to be diagnosed than those who do so from institutions, for example, like the NHS? Or through insurance perhaps. I'm not that familiar with this whole process. Enlighten me.

I sometimes wonder if clinicians are less likely to reject a diagnosis if they (patient) have paid for it. Has there been any research done into this, and do you think this bias exists?

Last edited by Acedia on 16 Apr 2014, 1:07 pm, edited 1 time in total.

Doctors, and clinicians have pritty much given me no more than stitches, and shrapnel removal when I needed it. I am actually more fond if super glue, if I can get away with using it... I remain unafilliated.

Not an exact answer to your question, bu there is all kinds of bias around payment, and if you pay for a diagnosis, you are more likely to buy what the person tells you. If you do not buy it, then in this case there may be more functional value in not buying it, but people who are already self-diagnosed and/or suspect they are autistic are the ones who would probably put their money down to go to a professional, so they are more likely to accept the diagnosis, which is more likely to actually be true as I think it is pretty easy to self-diagnosis and generally speaking get it right.

This is an aside, but in terms of working with a therapist from a psychological angle, I do think that people who pay are more likely to get something out of it, but again, if they are putting their own hard-earned money down, they are more likely to buy what he says, but they are also more likely to really listen, actively process the data and try to work on themselves.

Ethically, it should not happen, but it stands to reason if you want a positive Dx for AS/Autism, you likely have a better shot going to a specialist and PAYING HIM/HER for it. If you are up front about what you want and why you want it, they can let you know what they can and can't do.

If you go via a "free" (or "free to you") route, the specialist doesn't have to do anything for you if they don't feel like it.

In a way, a Dx from someone NOT paid by you should be more credible than one you paid for...as it's simple to find specialists who will say pretty much whatever you want for a price. Lawyers call them "expert witnesses."

If someone's paying a psychologist to do a thorough assessment because they really want X diagnosis and they make that clear to the professional that could influence the diagnosis.We are relying on a human's judgement. Probably some professionals have more integrity than others and would be less likely to do this.

Sometimes people go to private specialists when the ones they're given for free give them answers they don't like (in countries that have universal health care, I mean). Situations like that are more likely to lead to wrong diagnoses for the reason in the above paragraph, I would think (not that it would necessarily -just more likely than in other situations).

Do you think there should be a law, something like a diagnostic integrity act - to ensure good standards when diagnosing?

In theory yes, but how would you prove it? If they diagnose over a certain percentage of patients and they are paid they get a criminal record?

I'm sure there are laws already in place as well is guidelines from the collages that hand out the licences and renewals that are needed to practice these professions. The problem is without someone confessing it is next to impossible to prove anything since its all based on personal opinion. I am surprised governments and insurance adjusters don't do their own independent assessments and simply accept a diagnosis as fact. Simple fact, money talks.

In my opinion, there is payment bias both ways. I have a diagnosis from a private clinician as well as from a state government hired clinician. In my case, both came up with the same diagnosis, but I have heard so many people saying that doctors contracted by the state will see them for 15 minutes and say nothing is wrong with them. I have witnessed it personally, not with a psychiatric diagnosis, but with the physical diagnosis. A person than I was close to had severe back problems and had no less than six doctors confirm the severity of the problem, however, when she went to a doctor contracted by the state. The doctor literally said there was nothing wrong with her after seeing her for 15 minutes and not even doing so much as a visual examination of her back. Her disability was held up because of that one Dr.

People talk about ethics and morals, but the reality is doctors have bills to pay to and want nice things. With the private pay Dr. they have an incentive to give you a diagnosis because with the diagnosis, you are likely to see them for treatment and thus pay. If they tell you nothing is wrong with you, then they get their money for the visit and that's it. The real money is in therapy a diagnosis. On the flipside, doctors that do nothing but fulfill state contracts, if they don't side with the state, then the state will find a different contractor. They have a financial incentive to side with the state, which is in most cases against the patient.

In an ideal world morals and ethics determine outcomes. In the real world, it's money. I consider myself very lucky that the state contractor that I saw overwhelmingly sided with me, and the psychologist does nothing but state contracts. In my opinion, that is the exception rather than the rule.

I have no idea.
I was diagnosed by a psychologist, but I'd never even heard of Asperger's prior to that, I was going just for therapy and mentioned that I thought maybe I had a milder form of what some autistic kids I'd seen a documentary about had.
Months later she asked me if she'd given me a diagnosis or if I had ask, and I said no, and then she told me that had actually made the diagnosis several months before and forgot to tell me.
I was paying her as a therapist, but I wasn't fishing for a diagnosis, I was just trying to work out some issues I was having.

Never been to a state sponsored doctor, and never really had anything other than that one diagnosis.
I'm sort of jealous for the people who get diagnosed these days and are immediately pointed to resources & such.

Who is pointed to resources? If you're an adult There's really nothing out there. You will never get any kind of services based strictly on an autism diagnosis except for the most severe cases. If your verbal, you'll probably be fighting the state for two years for disability benefits. And you might not even get them after going through two years of hell. Don't be jealous.

Still doesn't work. The servant belongs to the master.

If government, your employer, the other party, etc. PAID for the evaluation, it's not credible if it comes out in their favor.

This goes on in many aspects of legal issues. What's often used is an IME (independent medical examiner) who is a professional evaluator paid by the court (both/all sides kick in an equal share of the cost) who all sides can agree is sufficiently neutral to the parties involved.

Of course in the matter of disability claims not arising from an insurance claim (e.g., accident or workplace injury), the person wanting benefits can't afford multiple efforts to Dx their condition, so requiring them to pay for multiple evaluations by different people and then pay for an IME is a real hardship.

"You will never get any kind of services based strictly on an autism diagnosis except for the most severe cases."

That's not true, and I know that for a fact.
I recevied assistance from the state in getting a job based solely on my diagnosis & the fact I wasn't employed but wanted to work.
In California there's an agency whose only purpose is to help people with any documented disability who want to work get & keep a job.
All I had was a single letter from my psychologist confirming my Asperger's diagnosis, which was enough to receive services from them which did help me land a job and get into the field I'm currently in.
I wasn't asking for a free ride, just a hand up, and the state gladly provided me that, and even money for transportation, all free of charge, and all based on my disability, though I'm fully (overly) verbal & high functioning.

I didn't find out about this until I was 30 though, a decade after I was diagnosed, through the 'one-stop' employment centers they have here, and I really wish I had known about it years earlier.

Applying for disability would be a last resort for me, because it's really hard to live on, harder to get off of, and I'm capable of working even if it's difficult, so I try my best & do what I can.
However, I was referring to places like this forum & other Autism groups almost none of which even existed when I was diagnosed (and no one knew abnou the few that did to point me to them).
There were no resources to find out about it, no one who knew anything about it or anyone who was like me.
It was lonely & confusing & took years to convince even my close friends & family that my condition was a real thing because no one had heard of it, it sounded made up, and there were no resources for me to point them to or use to help me understand it better myself, no support from others like me, no community, nothing. There was just me, my allistic friends who didn't believe it was real and refused to discuss it wth me, and my therapist.

So yeah, I'm a bit jealous of those who come into it with all the information, resources, community, and support available to them these days, and legitimately so.

Just because they're not supporting you financially & fixing your life for you doesn't mean they aren't huge, incredible resources for people with autism which up until very recently did not exist AT ALL.

I'm sorry if you're having a tough time of it and I hope things improve for you, but at least you have this place & ASAN & other Autism support groups & orgs and a ton of resources both on & off the web to help you deal with & learn about it.

I had none of that, I was just a lone aspie without anyone to even compare notes about it with who got laughed at & ridiculed for even mentioning 'Asperger's Syndrome' outside my therapist's office.

A psychiatry register, and a diagnosis can't be made on a first interview. When diagnosing a condition like autism, it should be a lengthy process. Childhood files and so on.... Also 3rd party observers too. A diagnosis can only be made if the condition impairs functioning. And each case has to be verified by a third party entity??

Clinicians can be reprimanded or lose their license if they break rules.

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