Do Doctors Provide Good Financial Care?
Your doctor may be expert at diagnosing and treating your physical ailments, but if you think he's going to keep a watchful eye on your wallet as well to prevent financial injury, think again. According to a new study, although doctors are very likely to recommend a generic over a brand-name drug to save patients money, when it comes to more complicated medical decisions, they frequently fail to consider patients' potential out-of-pocket costs.
In this era of consumer-driven healthcare, in which patients are expected to take greater responsibility for both managing and paying for their medical care, that can pose a real problem. As employers continue to shift more healthcare costs onto their employees' shoulders, and as high-deductible health plans that require hefty out-of-pocket payments before coverage kicks in gain traction in the marketplace, cost considerations have taken on a new urgency.
Researchers from the nonprofit Center for Studying Health System Change and the University of Chicago Hospitals asked 6,628 physicians whether they considered a patient's out-of-pocket costs in three specific instances: when prescribing a generic or brand-name drug, deciding which diagnostic tests to order, or choosing between inpatient and outpatient care settings. The study, which appears in the April 9 issue of the Archives of Internal Medicine, included both primary-care physicians and specialists.
Most doctors, the study found, are patient-savvy about drug costs. Eighty percent of doctors surveyed said they consider out-of-pocket costs when making prescribing decisions about generic vs. brand-name drugs. But that number dropped substantially for other medical decisions.
If a patient is complaining of chest pain, for example, should the doctor order a simple treadmill stress test or a much more expensive but definitive cardiac catheterization? Faced with an uncertain diagnosis, only 40 percent of doctors said they take patient out-of-pocket costs into account when deciding which tests to recommend.
A slightly higher percentage, 51 percent, said they consider patient costs when choosing whether to hospitalize a patient or treat him or her on an outpatient basis. Yet today many routine procedures, from gallbladder removal to hernia repair, may be performed in ambulatory care centers rather than hospitals.
The study found that primary-care physicians were more likely than specialists to consider patient costs in every instance.
There are many factors that influence how high patient cost-sharing may rank on a doctor's list of considerations, the study notes. In the case of generic and brand-name drugs, the choice is between two effectively equal options, so there's no downside in considering patient costs. But when it comes to ordering tests or performing an operation at one location or another, there may be trade-offs in safety, efficiency, and convenience, among other things, that matter more to the doctor than how much a patient will have to pony up.
Just as important, although drug prices are becoming more accessible to both physicians and their patients, it's often very tough to comparison-shop for medical tests or facilities.
"The crux of the issue is that there's no good patient cost data out there," says Hoangmai Pham, the study's lead author and a senior health researcher at the Center for Studying Health System Change. Benefit structures change from year to year, and with them patient cost-sharing responsibilities. Health plans often refuse to release specifics about patient costs before the fact, claiming it's proprietary information.
Patients, moreover, may feel embarrassed discussing how much their care will cost, says Mai. But in this era of consumer-driven healthcare, it's critical to overcome such qualms. Mai recommends that patients first bone up on what their plan covers and how much they're responsible for paying for services. Armed with that information, they'll be better able to discuss the financial aspects of any proposed treatment or service. Don't fret. Your doctor will most likely be more open to talking money than you imagine.
"In this day and age, physicians are not going to be offended if patients bring it up," she says.
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