The rising costs of health care in America, and consumers’ growing cost burdens, has many impacts on the U.S. health ecosystem. In particular, patients have been self-rationing due to costs, without necessarily paying attention to quality or medical outcomes.
Doctors have begun to pay more attention to costs and their impacts on patients in their practices, addressed in today’s New York Times article, Treatment costs could influence doctors’ advice to patients.
Andrew Pollack writes in the Times about the morphing role of doctors, some of whom are taking on the mantle of being a “steward of society,” as characterized by Dr. Lowell Schnipper who has worked on a task force on the cost of cancer drugs for ASCO, the professional association that focuses on clinical oncology.
There are some physicians getting more comfortable, and even committed, to taking on a role to help patients assess the cost-effectiveness of drugs and therapeutic choices. Pollack gives one example of treatments for macular degeneration, which can range from $50 a dose to $2,000 a dose. In the case of this wide range, a patient-as-consumer can face a huge difference in out-of-pocket dollars.
Complicating this decision is that some doctors recommend some drugs for some conditions that are deemed “off-label” — that is, not developed specifically for the use the physicians prescribe. Thus, more conservative (in terms of treatment protocols and potential liability) doctors may feel compelled to use a much more expensive treatment, when a patient may prefer the lower-cost treatment that’s off-label.
Doctors’ professional societies are wrestling with this new role, and patients have already begun to take on the role of health economist for themselves making cost-outcome-preference tradeoffs in their real life.
Health Populi’s Hot Points: Seventeen of the thirty professional doctor societies have already integrated the issue of costs into medical treatment guidelines — indicating a true tipping point in physician leaders recognizing the importance of health finance in treatment decisions with patients. This is a positive sign for shared decision-making — where clinicians and patients come together to get up-close-personal-and-real about peoples’ preferences and goals — which include economic ones, like end-of-life decisions and personal financial goals.
Patients will welcome these needed conversations. As health care continues to go more retail — with costs and decisions getting relegated closer and closer to patients, consumers, and caregivers — doctors-as-health-economists should and will become a norm to bolster consumer-directed health care.