Doctors are notoriously price insensitive, if not flat-out oblivious to the financial cost of the care we deliver. In a rational economic environment, our utilization should go down as costs rise. But our health care system is anything but rational when it comes to a price tag. As I’m sure most of you would agree: When costs go up, we aren’t the least phased.
That’s no surprise given the fact that we are largely sheltered from any sticker price when we wield our mighty pen. And, obviously, health care is considered an essential service. Thus demand remains constant, at least to date, regardless of price. That price tag in aggregate now may be as high as 18% of GDP with a projected growth to 25% of GDP by 2025.
But an observational study awesomely titled, “Surgical Vampires and Rising Healthcare Expenditures,” suggests that we become more sensitive to price if we are forced to be aware of it. I find it very interesting to think that I may be significantly less likely to click on an extra CBC if that electronic order was positioned next to the following: “Retail $79.99. Wholesale $49.99. Coupons not valid with any other offers. Returns without receipt good for store credit only.” Or something to that effect.
While the study is thought-provoking, my guess is that once the initial sticker shock wears off, the actual cost would quickly become more white noise in a day filled with chronic and unheeded distractions. Taking this to the extreme, I would hate to be the defendant in a missed appendicitis case in which the plaintiff’s attorney was quick to show the jury the CPOE screen that spelled out, “CT with contrast: $1223.”
“Grandpa was worth it!” the attorney would argue. And you can bet that any evidence-based medicine indicating that another CT was not necessary would just become more white noise for the jury as it rushed to compensate the aggrieved.
But this is not where I was headed when I started lighting up the pixels on my LCD. As director of a hospitalist program, I interviewed more than 40 docs last year and now well over 100 in my career. In this role, I have noted many changes in the queries aspiring hospitalists volley at me, especially recently.
And none is more pronounced that this: “You pay 200K, well that’s great. But how much for insurance for a family of four? And what is the yearly deductible?”
Dating back five years, I could just about predict the sequence of questions with almost 100% accuracy: Salary, Number of nights, Patient load, Malpractice with tail coverage, Vacation plan. Questions about benefits were largely an afterthought.
Today, especially among docs who have worked post-residency, health care benefits have vaulted up the priority list just behind salary. I think it is pretty remarkable that a doctor who makes almost $200K a year would be so concerned about how much his or her health care insurance costs. Remarkable but not surprising, given the ever-increasing cost of private insurance. One could list endless statistics about how rising health care costs have wrecked havoc on almost every economic class (well, maybe not that now infamous 1%), eating away at any real wage gains over the last 20 years. And 2012 is slated to bring another 8.5% increase in private health insurance.
Of course, our personal concerns over our own increased health care costs pale when compared to what we see each day in the hospital among the insured and uninsured alike. The uninsured, in my experience, generally focus their anxiety on access after discharge. The hospital costs are so astronomical that the average uninsured patient knows that his or her inpatient stay is gratis (which is not to say that many don’t wish they could pay for it). Because we know that the non-urgent CT they need can’t be done as an outpatient, they generally get it in the hospital.
But increasingly the insured, and especially the under-insured, have nearly the same level of angst. Not only are they paying much more now for health insurance, they are also facing higher copays and deductibles. And with insurance companies denying “unnecessary” inpatient care at an ever faster and more furious rate, the insured are more often triaged out of the hospital with a laundry list of undone tests and procedures they need to have done in follow-up. Each test, of course, comes with its separate copay and struggle for preauthorization.
It’s sadly ironic that we remain price insensitive when it comes to the health care we deliver, but not to the health care that we purchase. But there is no doubt that all the docs I know are increasing sensitive to the angst that rising health care costs are causing our patients. Perhaps in a reformed world–and this may be wishful thinking–our concerns for patients will be mirrored in a system that rewards us for practicing frugal, evidence-based medicine while protecting us from warrantless claims of rationing for not ordering extra, unneeded tests.
One can only hope.