The Problem With Patients In Controlling Health Care Costs

Carolyn McClanahan, Contributor, Forbes, March 26, 2013

We all know health care costs are a serious problem and most of us feel powerless to do anything about it. In this country, there is a perception that more health care means better health, and this is simply not the case. A recent article in Health Affairs by Roseanna Sommers, et al., beautifully outlines four challenges of involving patients in health care cost decisions. The study involved questioning twenty-two focus groups, and although the study is not scientific, it is very insightful and disheartening, with a good dose of appropriately optimistic solutions thrown in at the end. In this article, I share the results and of course provide my two-cents.

Challenge #1: Patients want only the best
To patients, health is paramount. This is understandable. When provided with two types of care, and even when told the second-best and cheaper choice was considered “good enough,” patients viewed the more expensive option as better. Many want the “best care” to eliminate all risk of missing something, which those of us in the medical field know is not possible. Of course, it is easy to make this choice if the patient and the family do not have to pay the bill. In the study, one patient stated, “… I wouldn’t care if it cost $10 million, give it here. I ain’t got $10 million, but give it anyway.” My take? On a societal level, we all want to reduce health care costs. On an individual level, too many people are not willing to budge when it comes to their health care choices. Rationing already occurs in our health care system, but maybe we need to take it to a different level. At least with taxpayer dollars, we should set limits on treatment that is appropriate and cost effective.

Challenge #2: Reluctance to make trade-offs between health and money
Patients are not accustomed to thinking about costs when choosing health care. Some felt the more expensive option would be cheaper in the long run. Others stated they bought insurance so they could avoid considering whether medical procedures were worth the money. One component of this challenge I found interesting? Many health experts, and me (not a health “expert” even though I am doctor) – “believe that financial insecurity can have negative consequences for patients’ health and well-being” – participants seemed to see health and finances as completely separate. I have news for you – poor health creates poor finances. I see this all the time. The majority of serious illness is preventable, and it is a shame patients let their health go without planning in advance for the price of poor health. I think people see this and know it happens, but refuse to believe it can happen to them. We could save a lot of money individually and as a country plus have a better life if we focus on wellness and prevention first. By the way, that is an important component of Obamacare.

Challenge #3: Lack of interest in costs borne by others
The participants in the groups felt they had done nothing to cause the problem of unsustainable costs, so why should they help solve it? They also were under the delusion that cost-consciousness was unnecessary to reduce health care spending. Finally, they had negative attitudes against the insurers and the government, and choosing higher cost options was a way to “stick it to the man.” This section truly depressed me and made me sad about my fellow humans. Of course, I am colored by my father’s reaction to his stage four lung cancer diagnosis. He refused treatment for two reasons – it wasn’t going to cure him and most poignantly he stated, “Why should everyone else have to pay for something I brought on myself?” Maybe that attitude got lost with the Greatest Generation.

Challenge #4: Noncooperative Behavior

About one quarter of the patients in the study reflected that it was in everyone’s long term interest to spare private insurers, Medicare, and Medicaid from extra expenses. However, most felt that personal interests trumped communal responsibility. Participants stated they didn’t believe others would cooperate with reducing health care costs, so why should the participant cooperate? Gratefully, these “focus groups” were just that – a bunch of people answering questions in a group, where group mentality can prevail. Attitudes are infectious. I would be curious to see how strong personalities citing responsibility and a concern for others in addition to the individual would change the answers of the group. This brings me to the optimistic part of the article, and regular readers know I like to operate from the optimistic viewpoint – ways to create substantial shifts in public attitude in health care spending. I read with glee the three examples they highlight, as all are great ways to reduce what I consider a significant public health problem – overuse of medicine. The chosen examples:


Concierge Medicine offers patients a choice in how they receive their health care. Concierge doctors and those physicians entering the concierge medicine or direct primary care market will need to consider these challenges and many more.


About Concierge Medicine Journal

Concierge Medicine Journal (CMJ) curates breaking concierge medicine news, and editorial opinion on a wide variety of topics relevant to the practice of Concierge Medicine.

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