People willingly drive across town to save 50 cents on a carton of milk. But when it comes to health care, they don't want to think about how much it costs, and they don't want their doctors to think about it either, according to a recent study in the journal Health Affairs.
That's not good news for those who hope to nudge people into being more cost-conscious health care consumers.
"Our findings present some challenges to doctors and to policymakers, insurers, employers — just about everybody who's concerned about the rising cost of health care," says the study's co-author Susan Dorr Goold at the Center for Bioethics and Social Sciences in Medicine at the University of Michigan.
Researchers probed the attitudes of 211 focus group participants in Washington, D.C., and Santa Monica, Calif. Participants were asked to weigh their own out-of-pocket costs as well as the costs borne by their insurer under scenarios in which the diagnostic and treatment options for various medical problems were nearly identical in effectiveness but varied substantially in price. For example, they were asked to consider getting an MRI versus a much less expensive CT scan if they'd had a headache for three months.
The results were discouraging. According to the researchers, the people in the focus groups generally did not understand how insurance works. In addition, they felt little personal responsibility for keeping health costs lower.
They were also unlikely to accept a less expensive treatment option, even if it was nearly as effective as a more expensive choice. Moreover, they were antagonistic toward insurers and seemed to be motivated to choose expensive care out of spite.
"There was an almost vengeful attitude toward insurance companies," says Goold.
Still, Goold says she's somewhat optimistic about the possibility that people can be encouraged to change their attitudes about weighing medical costs. She pointed to changes in end-of-life care over the past 30 years as an example. As hospice and palliative care have become widely accepted, the focus of patients, their families and providers has shifted toward improving quality of life through pain and symptom management rather than necessarily extending life.
Insurance plan design can also encourage people to think differently, she says. Value-based insurance design, for example, links patient out-of-pocket costs to the clinical value of a particular service. In the case of a patient who wants an MRI instead of a CT scan, under VBID the insurer could encourage the more cost-effective choice by charging a higher copay for the MRI.
"Although we know from other research [that] patients certainly consider their out-of-pocket costs, they're not very good at
deciding what's worth spending extra money on," says Goold. "Doctors have to be part of the discussion about the value of different options."