Bioethics Blogs

Missed Opportunities to Help Lower Patient Out-of-Pocket Expenses

Here is a Kaiser Health News/NPR story on our research on healthcare cost conversations in doctor’s offices.

Talking about money is never easy. But when doctors are reluctant to talk about medical costs, patients’ health can be undermined.

A study published Monday in the journal Health Affairs explores the opportunities that are often missed in the exam room.

Patients are increasingly responsible for more of their own health costs. In theory, financial incentives are supposed to make them sharper consumers and empower them to trim unnecessary health spending. But previous work has shown it often leads them to skimp on both valuable preventive care and superfluous testing.

Doctors could play a role in helping patients find appropriate and affordable care by talking with them about out-of-pocket costs.

But, a range of physician behaviors currently stand in the way, according to the study. “We need to prepare physicians to hold more productive conversations about health care expenses with their patients,” said Peter Ubel, a physician and behavioral scientist at Duke University.

The researchers analyzed transcripts of almost 2,000 physician-patient conversations regarding breast cancer, rheumatoid arthritis and depression treatment. They identified instances in which patients suggested the cost of care might be difficult for them to bear and assessed how doctors responded.

Overall, researchers noted two ways in which doctors dismissed patients’ financial concerns. They either didn’t acknowledge them or only addressed them halfway.

For instance, if a patient commented on how expensive a drug was, the doctor might ignore the comment entirely, or might suggest a temporary solution – like a free trial – without exploring long-term strategies to address the issue.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.