Possibly the biggest change that I’ve seen in clinical practice is the rising burden of health care costs on patients. On a daily basis I have difficult conversations with families as they face the grim reality of health costs offset in their direction. It’s captured pretty nicely here in this Bloomberg piece, Doctors are Fed Up with Being Turned Into Debt Collectors. It discusses the reality of high-deductible insurance and how it impacts the day-to-day work of the physician.
As high-deductible insurance continue to be a bigger part of our landscape there are 3 consequences that I see firsthand in my work as a physician:
Patients are more involved in health care decisions
This is good. When they’re accountable for some of the cost of care patients become invested in exploring how a given procedure might change the course of treatment. These conversations have been healthy, in my opinion. While most insured American health care consumers live with the belief that money is no object, the reality is that health care is expensive. These conversations are a confrontation of this reality and challenge the endemic ‘sky’s the limit’ mentality of health care spending.
Patients make the decision that they can’t afford care
This is not good. I spend part of my day fashioning treatment plans that work with what my families can afford – alternate options to what might be the best clinical course of action. And for the first time in my career I hear conversations in conferences and national meetings about what key diagnostic tests were deferred based upon what a family could afford.
Small medical practices won’t keep up with high-deductible insurance
The reality of offsetting costs to patients will put further pressure on the shrinking population of ‘private practices’ as they allocate overhead to discussion, negotiation and collection of patient payments. In the zero-sum medical day this is not sustainable. And it’s another reason why we see the daily acquisition of practices by hospitals and health care systems in the United States. There are now more physician employees than there are physicians who own practices.
While confronting the cost of health care is critical, painful negotiation between doctor and patient at the point of care is not the way that this should happen. Improved transparency that helps families understand the changing landscape in advance of crisis is key. Until this happens physicians need to be sensitive to the positions of patients and negotiate treatment options that may not involve a single course of action.