Many Patients Object to Focusing on Costs

NCPA March 13, 2013

To rein in health care spending, health policy experts have proposed having patients weigh the costs and benefits of clinical options. If patients are involved at the provider level, controlling costs has been deemed ethically justifiable. Though the benefits of this cost containment strategy could be great, patients have numerous beliefs and attitudes that must change before spending can be reduced, say Roseanna Sommers and her coauthors in the journal Health Affairs.

This cost containment approach of physicians discussing treatment options with patients is more transparent and allows patients to have more input and understanding about the decisions and processes that affect their own out-of-pocket costs. Sommers and her coauthors convened 22 focus groups and determined that there are four barriers to patients taking cost into account.

• A majority of patients prefer the best care possible, even when the relative benefit it offers is only marginal. Cost becomes trivial to many patients who want to eliminate uncertainty and take preventive screening measures against rare diseases and conditions. The mentality of "do everything" prevails over "do something."
• Many patients are inexperienced with making trade-offs between health and money, indicating an inability to even perceive a trade-off between a less expensive option and more expensive option that is only marginally better. In fact, some patients even prefer to have their physician tell them what to do.
• Patients also exhibit an aversion to considering insurers' costs when choosing between treatment options. While most patients are familiar with the problem of unsustainable health care, they express skepticism that cost-consciousness is necessary and few accept they have any personal responsibility for the state of health care spending.
• Seventy-five percent of patients reflect the opinion that it is not necessarily in their best interests to reduce extra expenses for private insurers.

The study shows that many patients believe that medical decisions should not consider financial costs but only consider health. It indicates that public attitudes about health care costs must undergo a significant shift if patients are to engage in meaningful discussions with physicians that result in cost-conscious decisions. Such decisions would be useful in reducing the long-term projections of growing U.S. health care expenditures.

Source: Roseanna Sommers et al., "Focus Groups Highlight That Many Patients Object to Clinicians' Focusing on Costs," Health Affairs, February 2013, 2013.