Study Of Physician And Patient Communication Identifies Missed Opportunities To Help Reduce Patients’ Out-Of-Pocket Spending

Abstract

Some experts contend that requiring patients to pay out of pocket for a portion of their care will bring consumer discipline to health care markets. But are physicians prepared to help patients factor out-of-pocket expenses into medical decisions? In this qualitative study of audiorecorded clinical encounters, we identified physician behaviors that stand in the way of helping patients navigate out-of-pocket spending. Some behaviors reflected a failure to fully engage with patients’ financial concerns, from never acknowledging such concerns to dismissing them too quickly. Other behaviors reflected a failure to resolve uncertainty about out-of-pocket expenses or reliance on temporary solutions without making long-term plans to reduce spending. Many of these failures resulted from systemic barriers to health care spending conversations, such as a lack of price transparency. For consumer health care markets to work as intended, physicians need to be prepared to help patients navigate out-of-pocket expenses when financial concerns arise during clinical encounters.

Setting the stage for universal financial distress screening in routine cancer care

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Do Patients and Oncologists Discuss the Cost of Cancer Treatment? An Observational Study of Clinical Interactions Between African American Patients and Their Oncologists

“…23 However, other research has found that physicians often are hesitant about initiating cost discussions [24][25][26] and rarely fully engage with patients to resolve their financial concerns. 27 Several studies suggest that discussions of treatment costs in patient-physician clinical interactions are rare.…”

A Costly Colonoscopy Leads to a Delay in Diagnosis

“…Physicians usually do not address costs with patients, and thus miss opportunities to understand financial barriers to care or help patients reduce their out‐of‐pocket spending . As this case highlights, even motivated and engaged patients may not be able to advocate for themselves effectively, such as by asking whether changing the indication for a procedure might affect the out‐of‐pocket cost.…”