Asthma patients to docs: Can we talk about cost?

Asthma patients concerned about their ability to pay for medical care would like to talk about cost-related concerns with their physicians but often don't get that opportunity, say researchers at the University of Michigan School of Public Health.

In a recent study reported in the Annals of the American Thoracic Society, less than half of patients who expressed a preference for such discussions with their doctors reported having these conversations.

"Financial burden from out-of-pocket health care expenses poses significant safety concerns and risk of poor outcomes to patients and society when patients utilize risky strategies, such as nonadherence, to address these burdens," said Minal Patel, U-M assistant professor of health behavior and health education.

"Patients need to communicate with health care providers in order to access affordable options such as free samples, verification to access community assistance programs, a change a prescription or to adjust treatment recommendations."

Patel and colleague Jack Wheeler, professor of health management and policy at the School of Public Health and pediatrics and communicable diseases at the U-M Medical School, surveyed 422 African-American adult women with asthma. They found that 52 percent perceived financial burden and 72 percent reported a preference to discuss cost with their health care provider, yet only 39 percent did so.

Patel said doctors just may not be aware that patients need this kind of communication, or they may be hindered by social distance that makes the subject tough to approach.

Recent data from the National Health Interview Survey shows that 1 in 5 families in the U.S. experience trouble paying for medical care. Often both the perception and reality of financial burden causes patients to skip treatments altogether or cut back on dosages.

Cost-related nonadherence to medical treatment is prevalent with high- and low-income patients, and even can be found with people who appear to have resources such as health insurance, a job or steady income.

"Individuals with economic resources or whose situations suggest economic security may perceive or have actually experienced that their perceptions of burden were not taken seriously by their provider, since resources typically increase expectations to pay out-of-pocket," Patel said.

The study's authors said additional research is needed to determine whether communication about the cost of therapy is associated with health outcomes.