Beating the system. Some doctors think that health plan rules restrict their ability to treat their patients effectively, so they bend the rules to help patients get reimbursed by their health plans. Here’s a sentence from a study on this topic: “Physicians who agree with the statement ‘Today it is necessary to game the system to provide high-quality care’ reported manipulating reimbursement systems more often than those who did not agree with the statement

(64.3% vs 35.7%; P < .001).”

(a) Explain to a doctor what “P < .001” means in the context of this specific study. (Hint: See pages 485–486.)

(b) A result that is statistically significant can still be too small to be of practical interest. How do you know this is not true here? (Hint: See pages 508–512.)

550 Part IV Review