Healthcare costs are making America sick—financially and physically. While the numbers vary depending on the study, the conclusion can’t be ignored: Cost is a primary reason people avoid or delay care, even when they are insured. In fact, a recent NIH report found that 45% of respondents reported either delaying or avoiding care due to cost.
People are balancing fear of the unknown, concerns about unaffordability and the reality of near-term costs with the potential long-term negative impacts of not receiving care. Knowing that nearly 1 in 5 Americans have medical debt (about 18%, according to a study published in JAMA) and other troubling statistics do not help people trust they can afford care, and rightfully so. Medical debt is the single largest cause of bankruptcy in America, according to the National Consumer Law Center.
These delays in care have real-world consequences, affecting health outcomes. In fact, one-third admit they’ve had a condition become more serious because they put off receiving care.
This creates an opportunity for plans to help members reduce care avoidance and work with their providers to help prescribe price transparency. We must address the importance the cost of care plays in our well-being and health outcomes.
Who is responsible for the “cost conversation”
A Kaiser Family Foundation and New York Times survey found over 60% of people both with and without medical bill problems say doctors rarely, if ever, discuss the costs of recommended treatments, but people depend on doctors for care recommendations. Patient-facing medical providers generally aren’t aware of the cost of services or how they might vary when providing referrals. On top of that, according to Dr. Peter A. Ubel ’s book, “Sick to Debt: How Smarter Markets Lead to Better Care,” “patients are sometimes embarrassed to bring up financial concerns” and physicians “have not been trained to look for signs of financial distress.”
Should we blame doctors? In most cases, providers are not intentionally sending members to high-cost facilities and aren’t intentionally dodging the cost question. There are many factors that make costs complicated—health plan size and type, premiums, copays, deductibles and how much has already been paid in a given year, negotiated rates, differing facility charges and more. In extreme cases, prices for services can vary by 10 times depending on the payer or hospital—which can have a substantial financial impact.
Historically, it hasn’t been easy to know an individual member’s cost for a specific service, and doctors simply referred patients to their regular standbys without a thought about cost—in some cases sending them driving past several more cost-effective places on the way.
The good news? Things are changing
While it is concerning that those “responsible for most of the spending decisions … have no idea what the bill is” (according to Dr. Vivian Lee’s “The Long Fix”), the data points to signs that things are changing for the better. The government is giving cost transparency a boost in the form of regulations that are helping fuel headlines and expanding awareness of the variation within healthcare costs. People are now realizing they have options and can control where they go for many services.
There are some encouraging statistics, too, for patients who have faced medical problems in the past 12 months:
- 49% have checked with a doctor’s office about the cost a visit beforehand.
- 34% shopped around to find the best price for a medical service.
- Nearly 1 in 4 (22%) negotiated with a provider to get a lower price before receiving services.
It probably doesn’t come as a surprise that Millennials are leading the charge in placing a greater weight on discussions about prescription prices and lower-cost alternatives. They’re more proactive in doing this than older patients.
Cost transparency tools are more available and more frequently used than they were only a year ago, and there’s overwhelming support of requirements for health insurance companies to provide cost estimates. Recently passed federal mandates and some state legislation is sending hospitals and payers scrambling to meet requirements to show costs for common procedures. Now, more than ever, empowered consumers can make smarter healthcare decisions that will encourage providers to consider the cost of care for their patients.
Photo: Meriel Jane Waissman, Getty Images