Doctors, Patients Need to Talk About Care Costs
In a time of high deductibles, medical debt is rising.
No matter how great your physician is, there is one question he or she is unlikely to answer: “How much will that cost?”
It is not really their fault. Medical schools and residency training programs have traditionally shied away from teaching costs. For the most part, costs remain hidden even from many practicing physicians. Some would argue this is for good reason, since doctors should be making decisions based on medical need without clouding that judgment with considerations of potential costs. That intention is noble, but in practice, it often leads to doctors inadvertently saddling patients with expensive medical bills. Doctors and patients both need to better communicate about this problem and work together to find solutions if the financial burden would be too much.
A Monmouth University poll recently found that paying for health care is the top concern of American families, beating out job security and other household bills. Similarly, when Gallup asks Americans “what is the most urgent health problem facing this country,” cost consistently tops the list.
One reason for this concern is more Americans than ever are on high-deductible health plans. This means even seemingly simple medical decisions could result in substantial out-of-pocket costs for patients. With increased price sensitivity comes new requests.
Nobody knows exactly what the current administration will do to change health care coverage, but based on current Republican proposals it seems likely the number of high-deductible plans—and “consumer-driven health plans” such as health savings accounts—will continue to grow.
As the responsibility shifts more to patients covering the cost, the result is that more than a quarter of Americans say that someone in their household is currently struggling to pay medical debts. This leads to Americans putting off needed care.
When faced with a tragedy, too many Americans have their lives saved but their life savings decimated. Oncologists have begun to understand this problem, coining it “financial toxicity” and considering it an unintended consequence of their treatments. Just like other side effects of chemotherapy, such as losing one’s hair, this does not mean it is always avoidable, but at least by recognizing the issue, these doctors and patients can be more aware of the situation and can work on trying to navigate the problem together. Knowledge is power.
More doctors should care about the costs that patients need to pay, and help with ensuring that the recommendations they make are the best options for the patient sitting in front of them. For example, there are a wide array of choices for many medication classes, such as statins or oral contraceptives. Physicians can help identify the option that will be the most cost-effective for a given patient. Health care professionals also can learn and share specific “tips” with patients, such as informing them about the $4 generic medication lists or drug price lists.
A number of new tools are also emerging to make this easier for patients and physicians. One free website and application provides local searches to find the lowest-cost pharmacy for your specific prescriptions. When considering medical tests or procedures such as an MRI or knee surgery, there are a handful of options currently available for the public to research prices. Healthcare Bluebook and Guroo are two websites that claim to provide a search of prices within your area and to help you determine a “fair price.”
Physicians should go further and take responsibility for helping patients understand the complex world of medical financing. Oftentimes, it does not even have to be the physician, but rather a designated person within the practice who can give patients more in-depth answers.
Research studies show that patients often do not bring up their troubles with paying for their medications or medical care with their doctors. It is likely that this has created the illusion for physicians that their patients do not want to talk about costs, or that all is fine. Your doctors went to medical school because they committed to helping patients with their needs. If you need help with understanding the financial ramifications of their care, then you should start by asking about it.
Christopher Moriates, M.D., is the assistant dean for health care value in the Dell Medical School at The University of Texas at Austin. He will lead a session called “Hey Doc, How Much Will That Cost?” on March 12 at the 2017 South by Southwest festival.