The issue of cost in clinical decision-making is increasingly becoming necessary in the face of growing healthcare costs, limited resources, and often limited access to care. Involving patients in the cost discussion has been suggested as a way to begin to curb the rising costs of care. A new study investigated the inclination of Americans with health insurance to discuss their willingness to have cost as part of the decision-making in their care (Sommers R, et al. Health Aff [Millwood]. 2013;32:338-346).
The study population included 22 focus groups of Americans with health insurance from 2 geographically distinct metropolitan areas—Santa Monica, CA, and Washington, DC. Although all participants had insurance, they varied by age, race, education, and by income levels. At least 50% had incomes of <300% of the poverty level and 43% had incomes of <$40,000.
“We found that the majority of participants were unwilling to consider cost when deciding between nearly comparable options and generally resisted the less expensive, marginally inferior option,” the authors wrote. The 4 barriers to participants’ willingness to consider cost in treatment decisions included:
Overall, participants wanted the best care and were not interested in considering limited resources and making trade-offs between their health and money, holding physicians responsible to provide them the best care available, regardless of cost.
Based on their findings, the investigators conclude that “for cost to be an explicitly recognized and discussed factor in clinical decisions, public attitudes about health care costs must first undergo a significant shift.”
