Most U.S. physicians have trouble estimating out-of-pocket costs for their patients, suggesting hospitals should not rely on them to calculate and discuss these costs with patients, a new study published Nov. 5 in JAMA found.
Increasing healthcare prices and insurance cost-sharing requirements have made navigating healthcare costs more difficult. Even with insurance, around one-third of U.S residents have trouble paying their medical bills. Out-of-pocket costs are difficult to predict, too, with the cost of a medication potentially changing throughout the year depending on whether the patient has met their deductible or has more medical expenses.
These patients often turn to physicians to navigate the complexity. The study aimed to understand how accurately physicians could advise and estimate these costs for patients. The researchers surveyed 371 physicians across three main specialties, asking them about their attitudes toward cost conversations, as well as presented a scenario in which they were asked to estimate the cost of a prescription for a patient throughout the year.
The results revealed that 79 percent of physicians provided inaccurate estimates about at least one aspect of drug-related cost-sharing obligations. Sixty-six to 77 percent of the physicians also reported having a hard time advising patients on their out-of-pocket costs.
When patients are given accurate information about their out-of-pocket costs, they can more easily manage their financial decision-making. Physicians often do not have the time to help patients calculate these costs, even if they had a better understanding of health insurance systems. The researchers suggest that their data shows that hospitals and health systems shouldn't rely solely on physicians for advising patients on their costs given the inaccuracy of the estimates. Instead, insurance companies and health systems need to find other solutions to demystify healthcare costs for patients.