The Health Care Cost-Sharing Tipping Point

I meet lots of people who have much to say about the cost of health care.

This week I witnessed two very different perspectives.

. . .

Yesterday I met with a pleasant man about my same age.  One of our tasks was to choose a new medication for him to try.

I presented three good options, calling attention to the pros and cons of each, mentioning that one drug was far and away the most expensive.

His quick response?

 “I don’t care how much it costs.

That’s the insurance company’s problem.”

Okay.  I wasn’t expecting that.

Although easy to do, it would be unfair to draw a quick conclusion.  I don’t know his past experiences.  I have not heard his story.

It is not my role to pass judgement anyway.

In the end we decided against the pricy medication for a reason other than cost, but I wish time had allowed me the opportunity to explore his views further.

. . .

Today a visit went in a different direction.

An older gentleman told me that he was scheduled for several tests to monitor a past malady,  the arrangements made many months prior.  Afterward he was to meet with his treating physician to discuss the results.

The hospital surprised him this time by calling ahead to discuss payment.  His responsibility would be for $800, only a fraction of the total.

His comment?

“Regardless of my part, somebody has to pay all that!” 

He saw the bigger picture.

Can one infer a reason for the differing perspectives?

Would the first fellow think more like the second if he had more personal responsibility for the cost of his care–the “skin in the game” that many speak of?

Maybe so.  Maybe not.

However, the potential fallout was most concerning.

“I don’t have it,” he spoke of his portion of the estimated costs.

It was an all-or-nothing scenario in his eyes.  If he did not undergo the tests, there would be nothing to discuss with his physician.  So why do any of it?

He was considering abandonment of his follow-up altogether.

Recognizing that his care might be in jeopardy, I explained how speaking with his treating physician would hopefully reveal which of the studies was most pressing at this time.  There might be a reasonable variance from the standard protocol that would reduce cost without significantly affecting the quality of his care.

Only time will tell what he decides.

. . .

There is no doubt in my mind that cost-sharing motivates changes in behavior.

The dilemma is that everyone has a different tipping point.

I saw one patient this week who “relented” to a change in his prescription after his out-of-pocket cost rose to $22 per pill.  Another asked for a cheaper alternative to a medication that only cost $20 per three-month supply.

It appears to be human nature for us to snatch up anything and everything that we can get for free.

Recognizing this, the industry is passing on more costs to patients, and the trend is sure to continue.

The question is where to draw the line?

How can it possibly be determined when incentives for cost stewardship might jeopardize an individual’s care?

Stephen Meyers, MD

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