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07-02-2013 | Article

Patients ‘fail to consider how costs impact insurers, society’


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medwireNews: Patients are reluctant to have clinicians pay much attention to insurer costs when it comes to medical decisions, recommendations, and strategies, according to a Health Affairs study that gauged patients' perspectives on cost considerations and health choices.

"While it's obvious that patients have a direct interest in what they pay out of pocket, in the long run we think they would do well to recognize that the services they use have an impact on the cost of their health insurance premiums and ultimately what society's health care costs are," author Marion Danis (National Institutes of Health Clinical Department, Bethesda, Maryland), told medwireNews.

Danis and colleagues looked at the outcome of 22 focus groups (n=211) from two distinct locations in the USA. All participants had health insurance while differing in age, race or ethnicity, education levels, and income levels.

Participants were presented with scenarios in which physicians spoke with patients about diagnostic and treatment options with similar efficacy but varying costs, for example the use of magnetic resonance imaging versus computed tomography for severe headaches.

Scenarios either had patients take on the extra cost of the most expensive treatment as an out of pocket expense or had the insurer bear the cost. Participants would then discuss how the cost arrangements might influence their thinking and preferences.

Overall, a majority of participants were unwilling to consider costs when choosing between comparable options, and "generally resisted the less expensive, marginally inferior options," according to the study. For every positive comment concerning the willingness to discuss costs, four negative ones were conveyed. Comments that indicated an unwillingness to accept the less expensive option outnumbered those that expressed willingness by three to one.

Danis and team identified four barriers to weighing costs in a broader context: a preference for the best care option, regardless of cost; inexperience with making trade-offs between health and money; lack of interest in costs borne by society due to not understanding how insurance works, lack of perceived personal responsibility, and disdain for insurance companies and government; and self-interest despite knowledge of depleting limited resources.

"We have created this problem [of unsustainable healthcare spending] because we have been so hesitant to talk about the cost of healthcare and about setting any limits on spending on healthcare," Danis observed. "It becomes a self-fulfilling vicious cycle when it is politically untenable to talk about [costs]."

By Peter Sergo, medwireNews Reporter