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Patients object to weighing costs when making medical decisions—a report by Roseanna Sommers ‘15

In this month’s issue of the health policy journal Health Affairs, Roseanna Sommers '15 and coauthors report on the results of a study examining patients' willingness to discuss health care costs with physicians. The authors convened focus groups of insured individuals, asking them to consider costs of comparable clinical options and weigh those costs with physicians. They found among participants a general discomfort with the idea of allowing monetary considerations to enter health care decisions.

The authors identified four barriers to patients' willingness to take costs into account when making medical decisions: (1) a preference for what they perceive as the best care, regardless of the expense; (2) inexperience with making trade-offs between health and money; (3) a lack of interest in costs borne by others and particular hostility toward insurers; and (4) non-cooperative behavior characteristic of a commons dilemma.

Furthermore, Sommers and coauthors found that patients tend to prefer more expensive treatment options. They identified the following barriers to patients' willingness to accept less expensive alternatives: (1) the salience of unlikely but highly upsetting possibilities; (2) a desire for zero risk, rather than for reasonable risk reduction; (3) an assumption that high price signals high quality care; (4) the misperception that health care sustainability can be achieved by eliminating wasteful spending alone, without needing to forgo some marginally beneficial care; and (5) the belief that choosing more expensive care constitutes a kind of victory for patients over the insurance companies.

The authors observe that surmounting these obstacles will require new modes of patient and provider education and comprehensive efforts to shift public attitudes about health costs.

The abstract of the research can be found here: