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Doctors Avoid Talking to Patients About Money

By Pamela Jean
News | November 10, 2009

money-200px-wide.jpgHAYS, Kan. - A new study says that doctors need to talk with patients about money rather than just ignore the topic.

The researchers reviewed literature on relevant professional ethics and interviewed primary care physicians to see how the physician-patient relationship is changed by the current trend in consumer-driven health care.

"Consumer-driven health care" is an insurance industry buzzword used to describe the modern insurance plans that have high deductibles and high co-payment requirements. The advantage for insurance companies in these newer high-deductible plans is that consumers are less likely to use health care services at all or are likely to avoid any overuse of care since these first dollars are being paid directly by patients. This means that the insurance companies pay out less overall. In the high deductible plans, patients pay for more treatment themselves. One drawback can be that while making more frequent cost-related choices, patients may feel forced by finances to forgo lifesaving or life-improving health care.

Without timely or adequate access to their own medical records, patients may be confused about how to spend their limited health care funds wisely.

Having discussions with their physicians about how to spend their few dollars can, itself, be a very costly discussion that patients avoid - not just out of embarrassment but also because they cannot afford the additional visit to the doctor to get the doctor's opinion about what the medical records say and which services are the most important to pay for.

The physicians in this study described patients who left prescriptions unfilled or refused to get diagnostic treatments because they couldn't afford them.

One patient severed a finger in a farming accident, and his primary care physician fixed it - though he knew a surgeon at a hospital could better ensure limited nerve damage. The patient said he wanted his doctor to treat him - or would receive no treatment at all.

With health insurance open enrollment season under way - when tens of thousands of workers learn of increases in their deductibles and other out-of-pocket costs - the issue is especially timely, said Mark A. Hall, J.D., a professor of law and public health in the Division of Public Health Sciences at the School of Medicine.

Co-authored by Carl E. Schneider, J.D., of the University of Michigan at Ann Arbor, a summary of three years' worth of research on the subject, appears in the current issue of the Journal of Family Practice.

"Each year, doctors are finding more and more that patients are coming in carrying substantial deductibles and having to pay more out of pocket," he said.


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