Financial burdens: MDs need to share toxic side effects

Many physicians are failing to mention the costs of treatment, prescriptions, and diagnostic testing to patients, forcing them to face unavoidable healthcare bills after it’s too late, according to Peter A. Ubel, MD, of Duke University, and colleagues. The researchers argue that this regular occurrence must be overturned in their article, “Full Disclosure—Out-of-Pocket Costs as Side Effects,” published on Oct. 17 in the New England Journal of Medicine.

“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,” wrote Ubel and colleagues.

Healthcare costs have increased faster than the Consumer Price Index in the last 40 years, according to the article, which is directly increasing the financial burdens placed upon patients. Many are uninsured and must take care of these costs out-of-pocket, while others have insurance plans that shift part of the expenses back onto them through often-high deductibles, copayments, and coinsurance.

Such financial strains can force people to cut corners, potentially adversely affecting their health and well-being.

Both physicians and patients face social barriers in discussing costs, as physicians most likely haven’t been trained in discussing financial matters and patients and families may fear they’re jeopardizing their chances at receiving quality care and treatment.

The cost discussion, therefore, needs to become a crucial component of clinical decision-making. Such dialogue will give patients the option to select lower-cost treatment if viable alternatives are available. Patients will be able to decide if they want to make a tradeoff between a chance for medical benefit or less financial distress. Talking about expenses before the bills begin also gives patients a chance to look for financial assistance and avoid these burdens altogether. Finally, integrating financial considerations into clinical decision making could reduce costs for both patients and society in the long run.

Though it is currently difficult, and sometimes even impossible, for a clinician to know a patient’s out-of-pocket expenses, some general information is known. Additionally, insurance companies are developing better technology to estimate these costs, while several states have passed price transparency legislation in order to protect patients.

Starting dialogues about the financial costs of treatment must not be spearheaded only by physicians, but policymakers and healthcare stake holders as well.

“We can no longer afford to divorce costs from our discussion of patients’ treatment alternatives,” wrote Ubel and colleagues.