Tuesday, August 4, 2020

A Vital New Sign in Health Care

Environmental & Science Education
Edward Hessler

I've never had a conversation initiated by a physician rather than by me on the cost of health care--the financial effects on me. Three physicians from three different institutions--two in Virginia and one in Boston--concerned about the cost of care, "have changed how we work."

In an essay in STAT they write, "We now ask our patients about financial side effects at every encounter, after first explaining why we are doing this. We ask because it is rare for patients to tell us unprompted what financial challenges they are facing, what sacrifices they have made to adhere to their care, and when and where they haven't been able to get the care they feel they need."

The questions include "out-of-pocket expenses, including out-of-pocket costs at the pharmacy, copays or bills for any tests, such as imaging studies; copays for clinic visits; and how and when they spend their annual deductible. We pay attention to our patient's insurance coverage, knowing this might affect which drug we decide to prescribe, or which tests we recommend."

And the questions continue. Do "they sometimes leave prescriptions unfilled or split or skip doses. We ask what sacrifices they make to pay for their care. If we have time during the visit, we ask if out-of-pocket costs for health care prevent them from spending their money on something else important to them or their family. We sometimes also as our insured patients about their annual premiums, including whether they've gone up over the past few years and how that has affected them. When we ask,we learn And when the answers worry us, we search for solutions. After all, one of our mandates is to first do no harm". (my emphasis)

Their essay includes other financial consequences--some personal, others broader but which affect a patient more invisibly (higher taxes) such as safety net programs and government-funded health insurance programs.

The doctors are confident that they are not alone in doing this but think that it is not a common-enough practice. Medicine is becoming more holistic--listening more to patients about their concerns, all of them and this financial review strikes me as an important part of complete health care. Patients always come from and return to their surrounding environment. A visit to see a doctor often has ramifications for the patient, for their environment as well as for the physician.

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