According to NPR.com “People willingly drive across town to save 50 cents on a carton of milk. But when it comes to health care, they don’t want to think about how much it costs, and they don’t want their doctors to think about it either, according to a recent study in the journal Health Affairs. Researchers probed the attitudes of 211 focus group participants in Washington, D.C., and Santa Monica, Calif. Participants were asked to weigh their own out-of-pocket costs as well as the costs borne by their insurer under scenarios in which the diagnostic and treatment options for various medical problems were nearly identical in effectiveness but varied substantially in price. For example, they were asked to consider getting an MRI versus a much less expensive CT scan if they’d had a headache for three months. The results were discouraging. According to the researchers, the people in the focus groups generally did not understand how insurance works. In addition, they felt little personal responsibility for keeping health costs lower. As soon as this article hit the web I had a call from two physicians who challenged this study.
Over the last two years I have seen firsthand patients challenge the cost of MRI’s and other medical procedures. I even saw one patient get visibly angry at a nurse for suggesting that he have an MRI yelling “I know how much they cost and I’m not paying for one, even with insurance”. With healthcare costs consistently in the news over the last couple of years you have to wonder how anyone would not want to better understand healthcare costs.
First let’s consider a few things. When you are going to the ER because of a medical emergency you’re not going to challenge the staff when they want to conduct medical tests or administer drugs. You are there because of a medical emergency and trust the staff to do whatever is necessary to get you back on your feet. Then we need to consider demographic differences of generations which is key to ANY study like this. The Greatest Generation often takes at face value what their healthcare professional recommends regardless of costs. However research has shown that Boomers trust their physicians but they are also using the Internet to verify medical treatments.
Finally we know that fewer Americans reported having employer-based health insurance in 2012 than did in 2008, 2009, and 2010, but at 44.5% it is unchanged from 2011. At the same time, more Americans continue to report having a government-based health plan — Medicare, Medicaid, or military or veterans’ benefits — with the 25.6% who did so in 2012 up from 23.4% in 2008. Do you think they are going to just go with recommended treatments without considering treatment costs ?
Then there is this story from the Boston Globe “Patients, angered by surprise surcharges that hospitals tack on bills for doctor visits, are increasingly challenging these fees — sometimes even refusing to pay. Hospitals say the charges cover their overhead, but the fees are sometimes added to the bill even when patients are treated in offices miles away from the medical centers. The fees can reach hundreds of dollars, and some resistant patients end up being pursued by collection agencies. Others, such as Wendy Frosh, are dropping longtime caregivers in favor of physicians not employed by hospitals.
Tufts Medical Center charged Frosh a $500 “facility fee’’ for a routine 20-minute exam in an adjacent office building — on top of roughly $250 a surgeon billed for his services, she said. After complaining in vain to Tufts, Frosh switched to a new doctor. “I am willing to spend my money for my doctor — I am getting expert care,’’ said the New Hampshire resident. “I am not willing to pay $500 to sit in a waiting room.’’
Now I am not saying this study is completely bogus what I am saying is that this study raises more questions than it answers. I have led health market research for over 10 years and know what data is good and what data requires a more in depth study and this requires a more in depth study. We need to to segment patients by demographics, if they have health insurance and whether that insurance is partly paid by their insurer. I would argue that today patients are more concerned with costs than before but of course it depends on the situation (i.e. emergency and nature of health problem).
Before jumping to any conclusions I would recommend that anyone conduct more in depth research before making a blanket statement that patients don’t care about their healthcare costs and have no idea how their insurance works.