Comments on: Should doctors consider patients’ out-of-pocket costs?

By: Diora

Diora — Thu, 12 Apr 2007 20:47:00 +0000

Anon at 11:08, does it mean you never order tests for purely defensive reasons? Is your “yes” answer always truthful?

By: Dr Scott

Dr Scott — Wed, 11 Apr 2007 14:08:00 +0000

To understand why it matters you need to know the difference between efficacy and effectiveness. Efficacy is how well a treatment works under ideal conditions. Effectiveness is how well a treatment works in the real world.

If a patient decides he/she can't afford a treatment, the effectiveness becomes zero.

For any treatment to work, cost must absolutely be a considered factor (as well as efficacy, risk, convenience, etc.)

By: Anonymous

Anonymous — Wed, 11 Apr 2007 04:08:00 +0000

It doesn’t enter my mind. When a patient is in office they are there for the best care period. There is no waffling if I think a test should be ordered. I order they decide and the answer is always yes if they want to know if I would have the same test done on a family member out of pocket.

By: Anonymous

Anonymous — Tue, 10 Apr 2007 23:41:00 +0000

My BC/BS insurer now has costs of the most common procedures, tests, office visits, and surgeries on their website. The data comes from a company called Subimo. For instance, they list costs for spine MRI, mammograms, hip replacement surgery, etc. The costs they show are in-network, and they are the total cost, which is what the insurer pays plus what the patient pays. The patient would still have to know what their dedectible, copay or co-insurance was.

I think this is pretty useful, and at least it gives a patient a rough estimate of what certain things cost.

I imagine this same data is available somewhere for doctors to see.

By: Happyman

Happyman — Tue, 10 Apr 2007 19:05:00 +0000

Isn't it often too complicated to know what the costs involved for testing/procedures are? I find that most patients don't know if they have a deductible, etc., and only copay info is listed on the card.

In an ideal world, I agree wholeheartedly with a cost/benefit analysis of testing.

I think perhaps echocardiograms are the most over-ordered test done, perhaps because the ratio of reimbursement to cost is the highest of any procedure out there.
Any patient I send to a cardiologist's office for anything gets an echo (and probably stress test, holter, ekg even though i've already done it & sent it with patient)

By: Diora

Diora — Tue, 10 Apr 2007 18:11:00 +0000

Agree with first two posters. Awareness about cost has a potential to reduce unnecessary testing. A patient that pays a high deductible may be less likely to say “yes” to defensive tests or ask about the latest test he heard about on TV.

Moreover, I’d argue it is unethical to not consider the costs when it comes to tests ordered purely for defensive purposes. In this case, the patient ends up paying more for the doctor’s peace of mind than his or her own health.

By: David

David — Tue, 10 Apr 2007 17:33:00 +0000

I agree with the first commenter. There should be a cost/benefit analysis done and that should involve the patient.

I went to a physician a few months ago, and when discussing some testing, he said something to the effect of, "Well since you have really good insurance, I say we do X and Y. It's not like you'll be paying for it." I had to point out that I had a high deductible (that wouldn't likely be met), so I'd be the one paying for it. I made it clear though that I would have no trouble paying for it, if he thought the test was a good idea and not just something he was ordering on a whim because Someone Else was picking up the tab. He responded saying X by itself was probably enough.

So even though I said I'd have no trouble paying it, the idea that it wasn't some big rich insurance company eating the cost was enough for him to reverse his suggestion. I found that a bit interesting.

The trick, I think, for many doctors, is knowing which patients can be rational about their care and which will not be. But I'm just speculating.

By: Gasman

Gasman — Tue, 10 Apr 2007 16:41:00 +0000

I’d argue the opposite, with this stipulation; whether to consider patient costs or not must be explicitly determined with each patient.
Some patients can be quite rational with their expenditures for health care as they are with other expenses. They wish to know that dollars spent have some probability of having some benefit. How much probability and benefit are will determine whether their expenditure is warranted versus other items with cost vs benefit/reward, like a college education, extra airbags in the car, or dish TV.

The patient’s ability to afford options would not change the physician’s advice. The physician would merely lay out the cost vs benefit for the strategies, allowing the patient, after this and other elements of informed consent, to choose what is best for them.