Talking points to broach when tackling costs with patients


It can be tough to talk money, but for patients in the healthcare setting, it gets a whole lot easier when there is a strong trust bond established with a physician, according to a recent National Institutes of Health Clinic Center report.

For physicians, though, such relationships can be difficult to establish, especially when visit time is often significantly limited. Taking that current reality into consideration, researchers set out to uncover successful communication tactics with which physicians can broach the subject of cost (whether insurer promoted or fee-for-service) with patients.

The following methods arose as the most promising:

  1. Using empathy so doctors and patients are working as a team to address the issue of cost.
  2. Each party doing their part to address costs so the decision-making is fair.
  3. Emphasizing that the less expensive option is good enough and debunking the notion that the newest, most expensive treatment is the better choice.
  4. Educating patients about the impact of rising healthcare costs on their premiums.

Twenty focus groups inclusive of 211 insured patients were called upon by the research team to discuss healthcare consumer attitudes toward costs and discussions of costs. Different scenarios were relayed to the groups: “For example, patients were asked to imagine they had experienced the worst headache of their life for three months, for which their doctor recommended an imaging study (e.g., MRI or CT scan). The doctor explained that the difference between the two tests was marginal; the MRI, however, was twice as expensive as the CT. For all scenarios, participants discussed whether and how they would want their physicians to broach the topic of costs with them, and which treatment option they would ultimately choose. The researchers also observed participants' reactions to the four communications strategies.”

While patients were more apt to discuss issues of cost with physicians than most other medical professionals, the degree of the discussion depended on certain factors. Older and sicker patients were more likely to talk with doctors about costs than their younger counterparts; if they felt the discussion was rushed, the doctor was not financially versed and/or too impersonal, openness narrowed.

"Our findings suggest that trust is a valuable ingredient for honest conversations about how to make cost-effective treatment decisions,” wrote the study authors. “Given that patients are more receptive to discussing out-of-pocket costs, stronger efforts to educate the public about the importance, for their own sake, of controlling insurer costs is a possible strategy for enabling discussions about these costs."

The study was published in the latest issue of the Journal of General Internal Medicine.