- Patients are continuing to cite high out-of-pocket healthcare costs as significant barriers to care, putting more pressure on providers to identify and alleviate those problems, according to a new study from the University of Texas Southwestern.
A study conducted by UT Southwestern’s Center for Patient-Centered Outcomes Research (PCOR) looked at the impacts financial strain has on patient care. Nguyen and her research partners consulted 12 focus groups of patients visiting Crossroads Community Services. Individuals visiting Crossroads Community Services receive food assistance and other social services from the organization.
The team looked at the demographic profiles of each study participant to determine his or her ability to pay for medical care. These algorithms also identified when a patient may not be able to adhere to her treatment plans because of high healthcare costs.
The analysis revealed that healthcare costs are continuing to rank as some of the most important factors when patients make decisions about their healthcare. Patients will often forgo healthcare to pay for other necessities such as food or rent, making it difficult for lower-income patients to obtain healthcare when they need it.
Additionally, many patients are hesitant to discuss cost issues with their providers. Providers will often perceive these patients as noncompliant to treatment rather than in need of help, according to lead researcher Oanh Nguyen, MD, MAS, an assistant professor in the Department of Internal Medicine at UT Southwestern.
“Financial strain is the burden that prevents many low-income patients from being able to take better care of themselves,” Nguyen said. “This financial strain can cause nonadherence to physician recommendations that appear to reflect a patient’s lack of engagement in care. However, this ‘nonadherence’ is actually the result of rational and difficult trade-offs to cope with financial strain.”
This finding is not necessarily new. Numerous patient surveys have indicated that high healthcare costs make treatment unattainable, especially as patients balance payments for other necessities.
However, the reluctance for patients to discuss financial barriers with their providers suggests a need for a new path forward, Nguyen said. Providers must engage in a dialogue with patients to uncover the financial barriers patients may face to obtaining care.
Providers who can access social determinant of health (SDOH) data may be able to diagnose financial issues that could put a strain on patient access to healthcare.
“We believe our findings will help physicians better recognize the signs and symptoms of financial strain in patients, so that they can create a safe environment for patients to overcome their embarrassment by discussing these concerns and work with their patients to develop the best plan of care that works within the patient’s financial means,” Nguyen said. “For instance, discussing which medications cost more or less and which are safe to skip or stretch if necessary.”
Other healthcare professionals are working on better strategies for discussing cost with patients. As noted above, it is difficult for patients to discuss sensitive money matters with their providers, even if cost is prohibiting them from accessing their treatments.
It is important that providers look at patients’ lifestyles before labeling them as noncompliant, Lisa Roome-Rago, Director of Enterprise Outpatient Care Management at Advocate Health Care told PatientEngagementHIT.com in a previous interview.
“People don’t wake up in the morning and think ‘I’m not going to follow what my doctor told me to do today,’” Roome-Rago said. “It’s a matter of figuring out what’s actually going on and then trying to create a plan around that and minimize as many barriers as you can.”
Medical professionals and healthcare caseworkers need to flag the warning signs that cost is a cause for concern for patients. Patients who do not know how they will pay for their medications or who are paying full sticker price are usually not aware of just how expensive their treatments are, and therefore might not be purchasing and taking them, said Stuart Goldberg, a New Jersey-based oncologist.
When healthcare professionals do identify a patient who cannot afford their medications, it is useful to look for less expensive alternatives, change dosing, or identify which medications are not essential to a patient’s treatment plan.
“If you don't take the medicine, it doesn’t matter. You can pick the best treatment but if the patient doesn’t pick it up from the pharmacy because they can’t afford it, that doesn’t help the patient,” Goldberg said in a separate interview with PatientEngagementHIT.com. “If the patient does pick it up and she doesn't take the pill, that doesn’t help the patient either.”
As healthcare continues to value overall patient wellness, it will be important to cite the cost barriers preventing patient adherence to care. Whether patients avoid visiting the doctor or obtaining their treatment plants, providers must understand how to overcome those barriers to best facilitate treatment adherence.