Doctor, Why Can't You Tell Me How Much It Costs?

A few months ago, I was visiting a specialist employed by Rush University Medical Center here in Chicago for a routine visit. The physician is one of the best in his field, nationally known for his research and his bedside manner is the best of any physician I've ever been treated by. It's because of this that I go out of my way once or twice a year to receive treatment from him, rather than just seeing someone closer to my home or office.

I was recently in for a visit and he asked if I would be able to stay for some lab work. I asked about how much it would cost, and he said he wasn't sure as it depended on my insurance. I worried that it could be more than I wanted to pay, since I knew the labs would be taken in the hospital setting, but the option seemed more convenient than asking him to write down the tests he wanted, visiting my primary care provider and asking her to order them at her office, and then faxing him the results. When I got the bill, I realized I would have rather been inconvenienced: more than $800, or a little over $400 with my insurance discount. All billed to me since I hadn't yet met my deductible for the year.

And it's not just one physician here or there who can't estimate costs. It's pretty much every single one, and it's not their fault. I've asked my dermatologist for the cost of a new drug she recommended — she had no idea. I received the same response when I asked my PCP for the difference between a generic and name brand. She could tell me it'd be less, but not how much less.

A recent article on Robert Wood Johnson Foundation's website explores this phenomenon, arguing "It's time for physicians to consider treatment costs as a critical part of care." Costs play a large role in patient adherence to treatment plans, and therefore, outcomes and long-term costs.

Peter Ubel, MD, a professor at Duke and a recipient of the RWJF Investigator Award in Health Policy Research (who, may I add has one of the most entertaining websites of any health policy expert I've seen), sums up the extent of the problem:

"We have reached a point where patients’' out-of-pocket healthcare costs can have more of a negative impact on their quality of life than some illnesses.”

In the article Ubel urges physicians to talk openly about costs, so that patients are comfortable with speaking about financial constraints that may affect their adherence to a treatment plan. He also urges physicians to offer lower-cost drugs, and encourages patients to ask for them.

While his recommendations are useful in the current environment, patients deserve much more. Why can't my doctor (or PA, nurse, medical assistant) simply log into a database (perhaps linked to my electronic health record) and compare the cost of two similar drugs under my coverage? The information is available, but insurance companies have done little to help physicians and patients use it in treatment decisions. Patients would prefer lower-cost drugs in most cases, and insurance companies would reap the savings.

Sure, patients have access to their formulary and drug cost information, but it isn't user friendly, and unless you know in advance what drug your physician is going to prescribe before you go into his or her office, there's no way for the information to inform the prescription choice.

Consumer-driven healthcare, in my opinion, can't come fast enough. While I'm certainly not looking forward to dealing with a high-deductible health plan, I do look forward to the day when consumer demands drive insurance companies to give us, and our doctors, the information we need to actually make treatment decisions that don't totally ignore the fact that patients have to, in fact, pay for their care.

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