Report: Higher healthcare costs force docs to discuss economics with patients

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As healthcare costs soar and insurance plans require patients to pay more out-of-pocket expenses, physicians are put in the tricky situation of balancing healthcare at an economical price, according to research published in the November issue of the Journal of Family Practice.

After interviewing a sample of seven North Carolina-based primary care physicians, the study authors suggest that doctors assist their patients with both medical and financial questions.

“Doctors need to make their treatment recommendations in the context of what patients can and can’t afford, with the understanding that some patients can’t afford what they might recommend,” said lead author Mark A. Hall, JD, a professor of law and public health in the division of public health sciences at Wake Forest University School of Medicine in Winston-Salem, N.C.

The seven physicians interviewed offered a look at previous patient accounts where cost concerns were an issue. One example showed a patient who had a blood pressure count of 150 over 90 and neglected to fill his prescription because of an inability to pay prescription drug costs.

According to Hall and colleagues, doctors tend to steer clear of mentioning financial concerns with their patients because of a reference in the law of medical malpractice which states that physicians must provide the best care available and deliver the “gold standard of treatment.”

However, authors said “malpractice is of little concern” because some sort of treatment is better than none. Offering the second best treatment and “substandard options” are justifiable when patients understand the consequences, the researchers said.

“If physicians have an open conversation with a patient who subsequently chooses to take a cheaper route, there’s little chance of a lawsuit because the choice is ultimately for the patient, not the doctor, to make,” Hall said.

Based on their research, the authors recommended that physicians make patients feel comfortable when talking about financial problems. They also suggested that physicians become familiar with the costs of procedures, treatments and prescriptions, in order to enhance patient education.

“Normalizing with tone of voice and a matter-of-fact way, the patient picks up that this is not something embarrassing,” Hall said. “This is just a fact that the doctor wants them to know about.”

However, the researchers acknowledged that time is a major limitation to these suggestions. They estimated that financial discussions with 2,500 patients at 5 minutes and 55 seconds each could take up to 7.5 hours of time.