Summary: “Health care is the fourth largest share of household expense for the typical family in this country, behind housing, food, and transportation,” write Reshma Gupta, MD, MSHPM; Cynthia Tsay, MPhil; and Robert L. Fogerty, MD, MPH, in the AMA Journal of Ethics. “More than three-quarters of polled Americans with health insurance in 2005 reported being concerned about their ability to pay medical bills for routine care, and, … Recently, it has been reported that more than half (52.1 percent) of all debts in the US are due to medical expenses. These debts may in part be incurred because of a lack of price transparency and communication between patients and physicians concerning medical prices. … Why has cost control only recently become a rallying cry among clinicians? … Major reasons include a lack of information about costs among both physicians and patients and gaps in physician training about financial harms. … We suggest that medical centers take the following steps to promote cost transparency and to train physicians and patients how to have open discussions about costs and the risks of financial harm:
- Provide medical professionals and patients with local cost information about tests, procedures, and medications.
- Publicize data on costs and quality made available by the federal government through Hospital Compare.
- Increase monitoring of patients who are at high risk for financial harms.
- Increase access to community resources to assist patients at high risk for financial harms, including financial coaching, vocational training, and housing and food security programs.
- Promote institutional discussions about system-level changes to improve care coordination, population health, and preventative care.
“Patients and physicians have a joint ethical responsibility to discuss medical costs and to avoid financial harms for patients and society at large. Simply put, the United States cannot withstand the escalating cost of health care indefinitely. However, we believe that the recommendations outlined above, in combination with national policies and incentives, can improve cost transparency, help avoid financial harms, and promote ethical medical practice.” Reshma Gupta, MD, MSHPM, Cynthia Tsay, MPhil, and Robert L. Fogerty, MD, MPH, Promoting Cost Transparency to Reduce Financial Harm to Patients,” AMA Journal of Ethics.