Interesting survey results released earlier this month tend to show that no matter how consumer-directed health care may become, consumers may not be able to keep their out-of-pocket expenses in check on their own, because the physicians ordering diagnostic and therapeutic services are often ignorant of or indifferent to the out-of-pocket expenditure implications of their orders. 

Excerpted from the news release:

Increased patient cost sharing is likely to miss the mark in safely reducing health care spending because many physicians do not routinely consider insured patients’ out-of-pocket costs when recommending expensive medical care, according to a study by researchers at the Center for Studying Health System Change (HSC) and the University of Chicago Hospitals in the April 9 Archives of Internal Medicine.

While almost 80 percent of physicians consider patient costs when prescribing a generic over a brand-name drug, far fewer consider patient costs when deciding what diagnostic tests to recommend (40.2%) or deciding whether to hospitalize a patient when outpatient treatment is an option (51.2%), the study found.  [Emphasis supplied.]

"Most physicians reported routinely considering insured patients’ out-of-pocket costs in clinically straightforward prescribing decisions, but only half or fewer do so in more complex situations that allow greater clinical discretion," said Hoangmai H. Pham, M.D., M.P.H., the study’s lead author and a senior health researcher at HSC, a nonpartisan policy research organization funded principally by the Robert Wood Johnson Foundation, which solely supported the study.

"Because physicians consider patient costs less frequently in making decisions about more expensive services, it’s likely that increased patient cost sharing will be limited as an effective cost-control tool," said Pham, who coauthored the article with G. Caleb Alexander, M.D., M.S., of the University of Chicago Hospitals; and Ann O’Malley, M.D., M.P.H., an HSC senior researcher.

The study, "Physician Consideration of Patients’ Out-of-Pocket Costs in Making Common Clinical Decisions" is based on HSC’s 2004-05 nationally representative Community Tracking Study Physician Survey, which collected information from 6,628 practicing physicians. The survey response rate was 53 percent.

Noting that previous research has shown physician decisions affect how 90 percent of every health care dollar is spent, the authors point out that "whether increased cost sharing can effectively control health care spending depends on whether patients and physicians can together consider costs during clinical decision making."

Here’s hoping that physician communication with patients on such issues can find its way into provider report cards.  Perhaps we take a step in the right direction by tracking and reporting time spent providing charity care; another finding of the survey is that

[p]hysicians providing at least 10 hours of charity care a month were more likely than those not providing any charity care to consider out-of-pocket costs in both diagnostic testing (40.7% vs. 35.8%) and care setting decisions (51.4% vs. 47.6%).

David Harlow