How much does it cost? And why does it matter?

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How often do health care providers consider the cost of care? Should they be thinking about costs as they prescribe treatments? That’s the topic of a piece by Pauline W. Chen, M.D., published in The New York Times.

The  article was interesting enough, featuring the work of our friend Dr. Neel Shah over at costsofcare.org, but the comments were really interesting. Here’s a sampling:

A Medicare patient: “With third-party payment (for those who are lucky enough to have it) doctors, hospitals and patients are all likely not to consider costs sufficiently. I include myself –I’m about to have a knee replacement and so long as the doctor takes Medicare, my comparision shoppping is entirely about quality etc. On the other hand my 28 year old daughter doesn’t have work with benefits, so I pay some things out of pocket for her.”

A patient: “It’s astonishing that doctors admit to ordering unnecessary tests to protect themselves and not their patients. In any other profession such behavior would be profoundly unethical.”

A patient: “Doctors consider costs? Only to themselves, as in, what do I collect for this. I’m currently preparing my bankruptcy filing due to tests conducted on me without my authorisation while I was unconscious (my senile mother disregarded my medical directive). When I woke up, I tried to decline tests and was told I couldn’t (a lie – they thought they smelled money because our teardown’s in an ‘upscale’ zipcode). When I asked a doctor how much a test would cost, he screamed – literally screamed, that isn’t hyperbole – ‘how would I know!’ (More aptly, ‘why should I care?) So my credit rating is ruined, but he builds a deck on his second vacation home …”

A doctor: “There are several problems with providing a menu of services, with prices for patients. As one commenter has already mentioned, patients presenting for treatment or diagnosis are often unknown. The exam and procedures may be simple and an estimate of cost can be ascertained. More often, however, there is an underlying complexity that requires sequential testing and re-examination, the costs of which are virtually impossible to calculate from the beginning. For example, as a hematopathologist, my main job is to assess bone marrow biopsies. I could give an estimate for the cost of the biopsy procedure and examination of the slides. But, after initial assessment, to make accurate diagnoses to direct treatment, additional testing is almost always required and may range from hundreds to tens-of-thousands of dollars. This information is crucial for our clinicians. Inappropriate treatment for an aggressive malignancy can be devastating. Another issue I’ve encountered is that costs fluctuate wildly. Molecular tests a few years ago were prohibitively expensive but are becoming cheaper by the day. On the other hand, prices for things like novel drugs or more complex surgical procedures are rising exponentially. …

“I don’t get paid more for ordering more tests, I do it for the wellbeing of patients and would consider it malpractice to do otherwise. I agree, patients need transparency in the system, but forgoing appropriate medical care based on price is not the answer.”

Interesting discussion. Let us know what you think.