Higher health insurance costs force doctors to talk about money with patients

November 5, 2009

As health insurers require people to base more treatment decisions on out-of-pocket costs, physicians should learn to talk to patients about money, according to researchers at Wake Forest University School of Medicine.

With health insurance open enrollment season under way - when tens of thousands of workers learn of increases in their deductibles and other out-of-pocket costs - the issue is especially timely, said Mark A. Hall, J.D., a professor of law and public health in the Division of Public Health Sciences at the School of Medicine.

"Each year, doctors are finding more and more that patients are coming in carrying substantial deductibles and having to pay more out of pocket," he said.

Co-authored by Carl E. Schneider, J.D., of the University of Michigan at Ann Arbor, a summary of three years' worth of research on the subject,appears in the current issue of the Journal of Family Practice.

Hall said that doctors generally avoid asking patients about health insurance and finances because physicians want what they believe is best for their patients - and what's best might not always be most affordable.

However, Hall and Schneider say patients are counting on physicians to help guide them to the best treatment decisions - medically and financially.

The researchers reviewed literature on relevant professional ethics and interviewed who treat lower-income patients to see how the physician-patient relationship is changed by the current trend in consumer-driven health care - in which patients pay for more treatment themselves and therefore make more cost-related choices.

The physicians described patients who left prescriptions unfilled or refused to get diagnostic treatments because they couldn't afford them. One patient severed a finger in a farming accident, and his primary care physician fixed it - though he knew a surgeon at a hospital could better ensure limited nerve damage. The patient said he wanted his doctor to treat him - or would receive no treatment at all.

Hall encouraged patients to bring up financial concerns with their doctors.

"You shouldn't be afraid to talk to doctors about having to pay for things," he said, adding that doctors and patients talking about money is not a new concept. Doctors several generations ago, before employer-sponsored was standard, hashed out payment with patients daily, he said.

"We have forgotten that aspect of professional folk wisdom," Hall said. "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."

Hall said doctors need training on how to effectively talk with patients about money. The experienced physicians interviewed for this study suggested asking patients not about ability to pay, but instead about the extent of the patient's insurance coverage, to avoid the embarrassment some patients feel admitting they can't afford their doctors' bills.

"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 to know about."

Moreover, malpractice is of little concern. In previous studies, Hall and Schneider found that such conversations - and the treatment decisions they result in - created negligible legal issues for doctors. "If they 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.

Source: Wake Forest University Baptist Medical Center (news : web)

Related Stories

Recommended for you

Pickled in 'cognac', Chopin's heart gives up its secrets

November 26, 2017
The heart of Frederic Chopin, among the world's most cherished musical virtuosos, may finally have given up the cause of his untimely death.

Sugar industry withheld evidence of sucrose's health effects nearly 50 years ago

November 21, 2017
A U.S. sugar industry trade group appears to have pulled the plug on a study that was producing animal evidence linking sucrose to disease nearly 50 years ago, researchers argue in a paper publishing on November 21 in the ...

Female researchers pay more attention to sex and gender in medicine

November 7, 2017
When women participate in a medical research paper, that research is more likely to take into account the differences between the way men and women react to diseases and treatments, according to a new study by Stanford researchers.

Drug therapy from lethal bacteria could reduce kidney transplant rejection

August 3, 2017
An experimental treatment derived from a potentially deadly microorganism may provide lifesaving help for kidney transplant patients, according to an international study led by investigators at Cedars-Sinai.

Exploring the potential of human echolocation

June 25, 2017
People who are visually impaired will often use a cane to feel out their surroundings. With training and practice, people can learn to use the pitch, loudness and timbre of echoes from the cane or other sounds to navigate ...

Team eradicates hepatitis C in 10 patients following lifesaving transplants from infected donors

April 30, 2017
Ten patients at Penn Medicine have been cured of the Hepatitis C virus (HCV) following lifesaving kidney transplants from deceased donors who were infected with the disease. The findings point to new strategies for increasing ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.