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High Out-of-Pocket Costs a Hidden 'Side Effect'?

Some doctors say it's time to discuss financial aspects with patients

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"Patients in my practice as a medical oncologist were coming to me with growing concerns about the cost of their care despite having insurance," he said. "We as physicians don't really know what all of the costs are, but that doesn't mean we shouldn't bring up the topic."

One in five Americans is underinsured, paying at least 10 percent of their annual income on out-of-pocket health care expenses, Zafar said. A serious illness could ruin these people financially.

Reviewing the potential out-of-pocket costs of a procedure can be beneficial to patients, the authors said, by enabling the following:

  • Helping them choose lower-cost treatments when there are viable alternatives.
  • Assisting those who want to make an informed decision about trading potential medical benefit for less financial distress.
  • Allowing them to prepare themselves financially for an expensive procedure.

"Patient expectation plays a role in their level of financial distress," Zafar said. "If patients expect to pay a lot, they are able to cope better. If we prepare patients for the cost, even if we can't reduce the cost, preparation can go a long way."

Further, by considering costs in individual cases of clinical decision-making, doctors could play a crucial part in reducing overall health care costs for society as a whole.

Such conversations would be welcomed by patients, said Kim Bailey, research director for Families USA, a nonprofit health care advocacy group.

"Providers have been really hesitant to talk about cost, and they haven't thought a great deal about cost when talking with their patients about care," Bailey said. "In some ways, it's been seen as the provider's role is to focus solely on medicine, and that discussions of cost is really an insurance role."

It may take some training to help doctors grow comfortable adding a financial dimension to discussion of medical options, paper co-author Zafar said. Medical societies, advocacy groups and medical schools should consider playing a role in such training.

"It's a sensitive topic. It's embarrassing for many patients. And we as physicians don't have the knowledge base to talk about cost," he said. "But we give patients chemotherapy that we know is going to cause a physical toxicity we can't stop. We talk with them about how to best cope and expect it. That's how we should start thinking about the financial toxicity of some of the health care we provide."

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