Healthcare is often really costly. And with increasing frequency, a significant chunk of those costs is being passed on to patients in the form of high deductibles, copays, or other out-of-pocket expenses. As a result, millions of Americans struggle to pay medical bills each year.
What’s a poor patient to do?
For starters–they can talk to their doctors about these costs. According to a study my colleagues and I just published, when healthcare costs come up for discussion during clinical appointments, doctors and patients increasingly discuss strategies for how to lower out-of-pocket expenditures.
In the study, we analyzed transcripts of almost 2,000 outpatient clinical appointments, appointments audio recorded and transcribed by Verilogue Inc., a marketing research firm whose CEO, Jamison Barnett, was generous enough to collaborate with us on this research. (Full disclosure: All the doctors and patients gave permission to be audio recorded by the company. Verilogue removed all identifying information from the transcripts. And my colleagues and I did not enter into any financial relationship with the company, nor cede any control over our right to publish our findings.)
We analyzed three groups of patients, all of whom potentially face high out-of-pocket costs: breast cancer patients seeing their oncologists; rheumatoid arthritis patients seeing their rheumatologists; and patients with depression seeing their psychiatrists. We looked for any conversation that touched on the topic of healthcare costs–from discussions of whether insurance would “cover” a specific service (or whether the patient would instead be responsible for its cost) to patient complaints about out-of-pocket costs they’d already incurred from services ordered by their doctors during previous appointments.
In the first article published from these analyses (recently released on the website of Medical Decision Making), we focused on the strategies doctors and patients discuss to reduce patient out-of-pocket costs. And what did we find? That discussion of cost-reducing strategies was both common and rare. Common, in that once healthcare costs came up in the conversation, discussion of cost-reducing strategies occurred almost 40% of the time. Rare, in that healthcare costs came up as a topic of conversation in only 22-38% of the out-patient visits, meaning that in the majority of encounters, there was no discussion of healthcare costs, and thus no discussion of how to reduce patients’ out-of-pocket expenditures. Here is a picture showing those findings:
Sometimes doctors and patients found ways to reduce out-of-pocket costs without changing the plan of care. For example, doctors would refer patients to copay assistance programs, or give them free medication samples. Sometimes they would play around with the logistics of care, moving an expensive test up to December rather than January, so that the patient would not have to start spending through her deductible again.
(To read the rest of this article, please visit Forbes.)