New Study on Patients' Willingness to Consider Costs in Medical Decision Making

A new study in the latest issue of Health Affairs found that a majority of patients were reluctant to consider cost when making medical decisions, nor did they want their doctors to do so. Researchers investigated the attitudes of 211 focus group participants in Washington and Santa Monica, Calif. Participants were asked to weigh their own out-of-pocket costs as well as the costs borne by their insurer. The participants, researchers said, did not generally understand how insurance works and felt little personal responsibility for helping to solve the problem of rising health-care costs. They were unlikely to accept a less expensive treatment option, even if it was nearly as effective as a more expensive choice.

Specifically, the study identified the following four barriers to patients’ taking cost into account: 

• A preference for what they perceive as the best care, regardless of expense;
• Inexperience with making trade-offs between health and money; 
• A lack of interest in costs borne by insurers and society as a whole; and 
• Behavior characteristic of a “commons dilemma,” in which people act in their own self-interest although they recognize that by doing so, they are depleting limited resources. 

Surmounting these barriers will require new research in patient education, comprehensive efforts to shift public attitudes about health care costs, and training to prepare clinicians to discuss costs with their patients. Campaigns such as Choosing Wisely, as well value-based purchasing programs like reference pricing can help start to educate patients about appropriate utilization of services.