By David Pittman, Washington Correspondent, MedPage Today
“Admittedly, out-of-pocket costs are difficult to predict, but so are many medical outcomes that are nevertheless included in clinical discussions,” Peter Ubel, MD, of Duke University’s School of Public Policy, and colleagues wrote.
They noted in a New England Journal of Medicine perspective published Wednesday that patients can experience considerable financial strain from out-of-pocket costs, with little or no discussion beforehand about potentially avoidable health-related bills.
“Because treatments can be ‘financially toxic,’ imposing out-of-pocket costs that may impair patients’ well-being, we contend that physicians need to disclose the financial consequences of treatment alternatives just as they inform patients about treatments’ side effects,” the authors wrote.
They gave the example of a colon cancer patient who receives bevacizumab (Avastin), which can help prolong life by 5 months over chemotherapy alone.
Many providers don’t mention that the drug can cost $44,000 for 10 months of therapy, Ubel and others wrote. A Medicare patient responsible for 20% of the cost can expect $8,800 in out-of-pocket costs on top of other treatment costs, doctor’s fees, and diagnostic tests. The out-of-pocket costs can be even higher for patients with high-deductible insurance plans.
More than one in five patients covered only by Medicare (20.9%) reported some kind of financial burden, according to the National Center for Health Statistics data the authors cited. Even 30.4% of privately insured patients under age 65 reported some financial burden from medical care.
The authors suggested that taking the time to discuss what can be an uncomfortable topic may:
- Enable patients to choose lower-cost treatments when available
- Help patients who are willing to trade medical benefit for financial distress
- Enable patients to seek financial assistance earlier and avoid duress
In addition, evidence suggests that considering costs as part of clinical decision-making might reduce long-term costs to society, the authors noted. For example, some physicians feel it’s their responsibility to provide the best care regardless of costs, and patients worry that inquiring about prices will pit them against doctor’s orders and open them to subpar treatment.
Physicians lack training in this area, and may feel uncomfortable or may not know what a patient’s costs will be since it depends on what health insurance plan they have. “It is often difficult to determine a patient’s out-of-pocket costs for any given intervention,” Ubel and colleagues wrote.
But insurance companies are developing ways to better estimate patients’ costs, the perspective stated. Furthermore, policymakers need to push for greater price transparency, especially when it comes to prices borne by patients.
“We can no longer afford to divorce costs from our discussion of patients’ treatment alternatives,” they wrote.